AmeriCorps Seniors SCP Work Plan Development 

Worksheets

Overview and Instructions

1 

Overview

This is an optional tool to help you plan placement of your volunteers in Performance Measures for the three- year 

performance period, as specified in the Notice of Funding Opportunity (Notice) and Grant Application Instructions. By 

using these templates to pre-plan how your volunteers will be placed in service opportunities and activities, you can plot 

the scope of your AmeriCorps Seniors SCP project and your Work Plans. Additionally, the completed worksheets can be 

used as reference when you enter your Work Plan data into the eGrants System.

Instructions

1) As you complete these worksheets, we encourage you to reference the resources available on the Manage

AmeriCorps Seniors Grants page; particularly:

a. The NOTICE

b. Appendix B: AmeriCorps Seniors SCP National Performance Measure Instructions

c. AmeriCorps Seniors Grants Application Instructions Volume II

d. AmeriCorps Seniors SCP Resources for Independent Living and Respite Surveys

2) Use the following definitions when calculating “Total Number of Unduplicated Volunteers” and “Total

Number of Volunteers”:

a. Number of Unduplicated Volunteers: This is the proposed number of volunteers who will be

performing each service activity. Each volunteer can only be counted once when assigned to a service

activity. The volunteer should be counted in the area where he/she will make the most impact in terms of

the type of service or in terms of the scope of service, such as the most number of hours served.

b. Total Number of Volunteers: The total number of volunteers engaged in the activities, if you were to

assign all of them according to each activity, will be entered in this section. In this way, volunteers can be

counted more than once- for example, if the same volunteer does two different types of activities such as

meal delivery AND companionship, you can account for all assignments in this field.

TIP: When completing these worksheets and entering your volunteer numbers into the eGrants System, remember that 

the sum of Number of Unduplicated Volunteers from each work plan must equal the Total Number of Unduplicated 

Volunteers for the project.

Volunteer Calculation

1) The total number of unduplicated volunteers you must place into work plans that result in national

performance measure outcomes in the Healthy Futures, Aging in Place focus area= ________ volunteers. To

find this number, divide the annual federal funding on your grant renewal letter from your portfolio manager

divided by $6,500. For example, an applicant requesting $65,000 would be required to place 10 unduplicated

volunteers into work plans that resulted in national performance measure outcomes in the Healthy Futures,

Aging in Place focus area.
2) Your remaining number of unduplicated volunteers, if any = _______ volunteers

These unduplicated volunteers may be placed in any combination of outcome-based assignments, or Community

Priorities.

3) Use the worksheets below as needed to plan placement for your unduplicated volunteers and draft your work

plans.

Work plans use annual figures. Use the number of unduplicated volunteers, outputs, and outcomes you intend to

achieve in Year 3 of your program. If awarded, you will be able to make progress towards those goals in Year 1

and Year 2 of your grant.

4) For each service activity, you will create a new work plan. This is required in eGrants. All of the information

in the worksheets below is required for each work plan that results in national performance measure

outcomes. You will use a new sheet to draft each of these work plans. Ten sheets are provided. You may copy

and paste more if you would like more. You will need to select an outcome and replace all text enclosed in

brackets and colored red: [Red].

5) The last Worksheet in this document may be used for Other Community Priorities volunteers. See the specific

instructions on that sheet for more information.

6) When you are done, check your work. Ensure that the total number of unduplicated volunteers equals the

Year 3 requirement for unduplicated volunteers in work plans that result in national performance measure

outcomes in the Healthy Futures, Aging in Place focus area plus any remaining unduplicated volunteers.

The table below contains an example for an applicant that requests $325,000 in funding to support a service area

with a minimum of 50 unduplicated volunteers.

Baseline 

Funding Level

Total Current Undup. 

Volunteers

Total Unduplicated 

Volunteers Required in 

National Performance 

Measure Outcomes in the 

Healthy Futures, Aging in 

Place Work Plans

Remaining Potential 

Unduplicated Volunteers 

(May Be Programmed 

EITHER in other Healthy 

Futures Aging In Place 

Performance Measure 

Work Plans OR Other 

Community Priorities)

Ex.

$325,000 75 $300,000/$6,500 = 50

75-50=

25

7) Once you have completed these worksheets and you are ready to enter Work plan data into the eGrants

System, please refer back to the Grant Application Instructions for step-by-step instructions on how to enter

data into the Performance Measures and Work Plans Module.
Work Plan Development Worksheet Focus Area: Healthy Futures Objective: Aging in Place 

Community Need:

[Complete on your own, using the prompts in the Notice and AmeriCorps Seniors Grant Application Instructions]

A B C D E F G H I J

Output Output 

Instrument

Service Activity 

(each selected will 

generate a separate 

work plan)

# of 

Unduplicated 

Volunteers 

# of Total 

Volunteers 

# of 

Volunteer 

Stations

Output 

Target

Outcome Outcome 

Instrument

Outcome 

Target

H4A. Number 

of individuals 

served

Tracking 

System

[Complete from 

the available 

Service Activities 

in the table 

alongside this 

output. For 

example, 

“Companionship” 

or “Respite 

Services”] 

[Identify how 

many 

unduplicated 

volunteers will 

have this as the 

area where 

he/she intends 

to make the 

most impact] 

[Identify 

how many 

volunteers 

in all will 

contribute to 

this work 

plan] 

[Identify 

how many 

stations 

will 

contribute 

to this 

work plan] 

[Estimate 

your 

target for 

the output 

you 

identified 

in Column 

A]

[ You may select 

either outcome H9A: 

Number of individuals 

who report having 

increased social 

support or improved 

capacity for 

independent living 

[OR] H14: Number of 

caregivers of older 

adults and individuals 

with disabilities who 

reported having 

increased social 

support ]

[Choose the 

option that 

best 

describes 

the tool you 

will use to 

measure the 

number of 

outputs 

achieved.]

[Estimate 

your 

target for 

the 

output 

you 

identified 

in 

Column 

A]

Total number of unduplicated volunteers in National Performance Measure Work Plans: [COMPLETE]_____________________

Update this as you complete work plans to reflect the cumulative number of unduplicated volunteers programmed into National Performance Measure Work 

Plans. For example, if this is the first work plan I have completed, and I have included 10 Unduplicated Volunteers in Column D, the value would be 10. If this is 

my second, and I have included 10 Unduplicated Volunteers in Column D in each work plan, it would be 20, and so on. 

Service Activity Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 

Output Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 

Outcome Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 
Work Plan Development Worksheet Focus Area: Healthy Futures Objective: Aging in Place 

Community Need:

[Complete on your own, using the prompts in the Notice and AmeriCorps Seniors Grant Application Instructions]

A B C D E F G H I J

Output Output 

Instrument

Service Activity 

(each selected will 

generate a separate 

work plan)

# of 

Unduplicated 

Volunteers 

# of Total 

Volunteers 

# of 

Volunteer 

Stations

Output 

Target

Outcome Outcome 

Instrument

Outcome 

Target

H4A. Number 

of individuals 

served

Tracking 

System

[Complete from 

the available 

Service Activities 

in the table 

alongside this 

output. For 

example, 

“Companionship” 

or “Respite 

Services”] 

[Identify how 

many 

unduplicated 

volunteers will 

have this as the 

area where 

he/she intends 

to make the 

most impact] 

[Identify 

how many 

volunteers 

in all will 

contribute to 

this work 

plan] 

[Identify 

how many 

stations 

will 

contribute 

to this 

work plan] 

[Estimate 

your 

target for 

the output 

you 

identified 

in Column 

A]

[ You may select 

either outcome H9A: 

Number of individuals 

who report having 

increased social 

support or improved 

capacity for 

independent living 

[OR] H14: Number of 

caregivers of older 

adults and individuals 

with disabilities who 

reported having 

increased social 

support ]

[Choose the 

option that 

best 

describes 

the tool you 

will use to 

measure the 

number of 

outputs 

achieved.]

[Estimate 

your 

target for 

the 

output 

you 

identified 

in 

Column 

A]

Total number of unduplicated volunteers in National Performance Measure Work Plans: [COMPLETE]_____________________

Update this as you complete work plans to reflect the cumulative number of unduplicated volunteers programmed into National Performance Measure Work 

Plans. For example, if this is the first work plan I have completed, and I have included 10 Unduplicated Volunteers in Column D, the value would be 10. If this is 

my second, and I have included 10 Unduplicated Volunteers in Column D in each work plan, it would be 20, and so on. 

Service Activity Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 

Output Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 

Outcome Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 
Work Plan Development Worksheet Focus Area: Healthy Futures Objective: Aging in Place 

Community Need:

[Complete on your own, using the prompts in the Notice and AmeriCorps Seniors Grant Application Instructions]

A B C D E F G H I J

Output Output 

Instrument

Service Activity 

(each selected will 

generate a separate 

work plan)

# of 

Unduplicated 

Volunteers 

# of Total 

Volunteers 

# of 

Volunteer 

Stations

Output 

Target

Outcome Outcome 

Instrument

Outcome 

Target

H4A. Number 

of individuals 

served

Tracking 

System

[Complete from 

the available 

Service Activities 

in the table 

alongside this 

output. For 

example, 

“Companionship” 

or “Respite 

Services”] 

[Identify how 

many 

unduplicated 

volunteers will 

have this as the 

area where 

he/she intends 

to make the 

most impact] 

[Identify 

how many 

volunteers 

in all will 

contribute to 

this work 

plan] 

[Identify 

how many 

stations 

will 

contribute 

to this 

work plan] 

[Estimate 

your 

target for 

the output 

you 

identified 

in Column 

A]

[ You may select 

either outcome H9A: 

Number of individuals 

who report having 

increased social 

support or improved 

capacity for 

independent living 

[OR] H14: Number of 

caregivers of older 

adults and individuals 

with disabilities who 

reported having 

increased social 

support ]

[Choose the 

option that 

best 

describes 

the tool you 

will use to 

measure the 

number of 

outputs 

achieved.]

[Estimate 

your 

target for 

the 

output 

you 

identified 

in 

Column 

A]

Total number of unduplicated volunteers in National Performance Measure Work Plans: [COMPLETE]_____________________

Update this as you complete work plans to reflect the cumulative number of unduplicated volunteers programmed into National Performance Measure Work 

Plans. For example, if this is the first work plan I have completed, and I have included 10 Unduplicated Volunteers in Column D, the value would be 10. If this is 

my second, and I have included 10 Unduplicated Volunteers in Column D in each work plan, it would be 20, and so on. 

Service Activity Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 

Output Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 

Outcome Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 
Work Plan Development Worksheet Focus Area: Healthy Futures Objective: Aging in Place 

Community Need:

[Complete on your own, using the prompts in the Notice and AmeriCorps Seniors Grant Application Instructions]

A B C D E F G H I J

Output Output 

Instrument

Service Activity 

(each selected will 

generate a separate 

work plan)

# of 

Unduplicated 

Volunteers 

# of Total 

Volunteers 

# of 

Volunteer 

Stations

Output 

Target

Outcome Outcome 

Instrument

Outcome 

Target

H4A. Number 

of individuals 

served

Tracking 

System

[Complete from 

the available 

Service Activities 

in the table 

alongside this 

output. For 

example, 

“Companionship” 

or “Respite 

Services”] 

[Identify how 

many 

unduplicated 

volunteers will 

have this as the 

area where 

he/she intends 

to make the 

most impact] 

[Identify 

how many 

volunteers 

in all will 

contribute to 

this work 

plan] 

[Identify 

how many 

stations 

will 

contribute 

to this 

work plan] 

[Estimate 

your 

target for 

the output 

you 

identified 

in Column 

A]

[ You may select 

either outcome H9A: 

Number of individuals 

who report having 

increased social 

support or improved 

capacity for 

independent living 

[OR] H14: Number of 

caregivers of older 

adults and individuals 

with disabilities who 

reported having 

increased social 

support ]

[Choose the 

option that 

best 

describes 

the tool you 

will use to 

measure the 

number of 

outputs 

achieved.]

[Estimate 

your 

target for 

the 

output 

you 

identified 

in 

Column 

A]

Total number of unduplicated volunteers in National Performance Measure Work Plans: [COMPLETE]_____________________

Update this as you complete work plans to reflect the cumulative number of unduplicated volunteers programmed into National Performance Measure Work 

Plans. For example, if this is the first work plan I have completed, and I have included 10 Unduplicated Volunteers in Column D, the value would be 10. If this is 

my second, and I have included 10 Unduplicated Volunteers in Column D in each work plan, it would be 20, and so on. 

Service Activity Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 

Output Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 

Outcome Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 
Work Plan Development Worksheet Focus Area: Healthy Futures Objective: Aging in Place 

Community Need:

[Complete on your own, using the prompts in the Notice and AmeriCorps Seniors Grant Application Instructions]

A B C D E F G H I J

Output Output 

Instrument

Service Activity 

(each selected will 

generate a separate 

work plan)

# of 

Unduplicated 

Volunteers 

# of Total 

Volunteers 

# of 

Volunteer 

Stations

Output 

Target

Outcome Outcome 

Instrument

Outcome 

Target

H4A. Number 

of individuals 

served

Tracking 

System

[Complete from 

the available 

Service Activities 

in the table 

alongside this 

output. For 

example, 

“Companionship” 

or “Respite 

Services”] 

[Identify how 

many 

unduplicated 

volunteers will 

have this as the 

area where 

he/she intends 

to make the 

most impact] 

[Identify 

how many 

volunteers 

in all will 

contribute to 

this work 

plan] 

[Identify 

how many 

stations 

will 

contribute 

to this 

work plan] 

[Estimate 

your 

target for 

the output 

you 

identified 

in Column 

A]

[ You may select 

either outcome H9A: 

Number of individuals 

who report having 

increased social 

support or improved 

capacity for 

independent living 

[OR] H14: Number of 

caregivers of older 

adults and individuals 

with disabilities who 

reported having 

increased social 

support ]

[Choose the 

option that 

best 

describes 

the tool you 

will use to 

measure the 

number of 

outputs 

achieved.]

[Estimate 

your 

target for 

the 

output 

you 

identified 

in 

Column 

A]

Total number of unduplicated volunteers in National Performance Measure Work Plans: [COMPLETE]_____________________

Update this as you complete work plans to reflect the cumulative number of unduplicated volunteers programmed into National Performance Measure Work 

Plans. For example, if this is the first work plan I have completed, and I have included 10 Unduplicated Volunteers in Column D, the value would be 10. If this is 

my second, and I have included 10 Unduplicated Volunteers in Column D in each work plan, it would be 20, and so on. 

Service Activity Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 

Output Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 

Outcome Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 
Worksheet Focus Area: Healthy Futures Objective: Aging in Place 

Community Need:

[Complete on your own, using the prompts in the Notice and AmeriCorps Seniors Grant Application Instructions]

A B C D E F G H I J

Output Output 

Instrument

Service Activity 

(each selected will 

generate a separate 

work plan)

# of 

Unduplicated 

Volunteers 

# of Total 

Volunteers 

# of 

Volunteer 

Stations

Output 

Target

Outcome Outcome 

Instrument

Outcome 

Target

H4A. Number 

of individuals 

served

Tracking 

System

[Complete from 

the available 

Service Activities 

in the table 

alongside this 

output. For 

example, 

“Companionship” 

or “Respite 

Services”] 

[Identify how 

many 

unduplicated 

volunteers will 

have this as the 

area where 

he/she intends 

to make the 

most impact] 

[Identify 

how many 

volunteers 

in all will 

contribute to 

this work 

plan] 

[Identify 

how many 

stations 

will 

contribute 

to this 

work plan] 

[Estimate 

your 

target for 

the output 

you 

identified 

in Column 

A]

[ You may select 

either outcome H9A: 

Number of individuals 

who report having 

increased social 

support or improved 

capacity for 

independent living 

[OR] H14: Number of 

caregivers of older 

adults and individuals 

with disabilities who 

reported having 

increased social 

support ]

[Choose the 

option that 

best 

describes 

the tool you 

will use to 

measure the 

number of 

outputs 

achieved.]

[Estimate 

your 

target for 

the 

output 

you 

identified 

in 

Column 

A]

Total number of unduplicated volunteers in National Performance Measure Work Plans: [COMPLETE]_____________________

Update this as you complete work plans to reflect the cumulative number of unduplicated volunteers programmed into National Performance Measure Work 

Plans. For example, if this is the first work plan I have completed, and I have included 10 Unduplicated Volunteers in Column D, the value would be 10. If this is 

my second, and I have included 10 Unduplicated Volunteers in Column D in each work plan, it would be 20, and so on. 

Service Activity Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 

Output Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 
Outcome Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide 

all the information requested.] 

Work Plan Development Worksheet Focus Area: Healthy Futures Objective: Aging in Place 

Community Need:

[Complete on your own, using the prompts in the Notice and Grant Application Instructions]

A B C D E F G H I J

Output Output 

Instrument

Service Activity 

(each selected will 

generate a separate 

work plan)

# of 

Unduplicated 

Volunteers 

# of Total 

Volunteers 

# of 

Volunteer 

Stations

Output 

Target

Outcome Outcome 

Instrument

Outcome 

Target

H4A. Number 

of individuals 

served

Tracking 

System

[Complete from 

the available 

Service Activities 

in the table 

alongside this 

output. For 

example, 

“Companionship” 

or “Respite 

Services”] 

[Identify how 

many 

unduplicated 

volunteers will 

have this as the 

area where 

he/she intends 

to make the 

most impact] 

[Identify 

how many 

volunteers 

in all will 

contribute to 

this work 

plan] 

[Identify 

how many 

stations 

will 

contribute 

to this 

work plan] 

[Estimate 

your 

target for 

the output 

you 

identified 

in Column 

A]

[ You may select 

either outcome H9A: 

Number of individuals 

who report having 

increased social 

support or improved 

capacity for 

independent living 

[OR] H14: Number of 

caregivers of older 

adults and individuals 

with disabilities who 

reported having 

increased social 

support ]

[Choose the 

option that 

best 

describes 

the tool you 

will use to 

measure the 

number of 

outputs 

achieved.]

[Estimate 

your 

target for 

the 

output 

you 

identified 

in 

Column 

A]

Total number of unduplicated volunteers in National Performance Measure Work Plans: [COMPLETE]_____________________

Update this as you complete work plans to reflect the cumulative number of unduplicated volunteers programmed into National Performance Measure Work 

Plans. For example, if this is the first work plan I have completed, and I have included 10 Unduplicated Volunteers in Column D, the value would be 10. If this is 

my second, and I have included 10 Unduplicated Volunteers in Column D in each work plan, it would be 20, and so on. 

Service Activity Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 

Output Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 
Outcome Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all 

the information requested.] 

Work Plan Development Worksheet Focus Area: Healthy Futures Objective: Aging in Place 

Community Need:

[Complete on your own, using the prompts in the Notice and AmeriCorps Seniors Grant Application Instructions]

A B C D E F G H I J

Output Output 

Instrument

Service Activity 

(each selected will 

generate a separate 

work plan)

# of 

Unduplicated 

Volunteers 

# of Total 

Volunteers 

# of 

Volunteer 

Stations

Output 

Target

Outcome Outcome 

Instrument

Outcome 

Target

H4A. Number 

of individuals 

served

Tracking 

System

[Complete from 

the available 

Service Activities 

in the table 

alongside this 

output. For 

example, 

“Companionship” 

or “Respite 

Services”] 

[Identify how 

many 

unduplicated 

volunteers will 

have this as the 

area where 

he/she intends 

to make the 

most impact] 

[Identify 

how many 

volunteers 

in all will 

contribute to 

this work 

plan] 

[Identify 

how many 

stations 

will 

contribute 

to this 

work plan] 

[Estimate 

your 

target for 

the output 

you 

identified 

in Column 

A]

[ You may select 

either outcome H9A: 

Number of individuals 

who report having 

increased social 

support or improved 

capacity for 

independent living 

[OR] H14: Number of 

caregivers of older 

adults and individuals 

with disabilities who 

reported having 

increased social 

support ]

[Choose the 

option that 

best 

describes 

the tool you 

will use to 

measure the 

number of 

outputs 

achieved.]

[Estimate 

your 

target for 

the 

output 

you 

identified 

in 

Column 

A]

Total number of unduplicated volunteers in National Performance Measure Work Plans: [COMPLETE]_____________________

Update this as you complete work plans to reflect the cumulative number of unduplicated volunteers programmed into National Performance Measure Work 

Plans. For example, if this is the first work plan I have completed, and I have included 10 Unduplicated Volunteers in Column D, the value would be 10. If this is 

my second, and I have included 10 Unduplicated Volunteers in Column D in each work plan, it would be 20, and so on. 

Service Activity Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 

Output Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 
Outcome Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 

Work Plan Development Worksheet Focus Area: Healthy Futures Objective: Aging in Place 

Community Need:

[Complete on your own, using the prompts in the Notice and Grant Application Instructions]

A B C D E F G H I J

Output Output 

Instrument

Service Activity 

(each selected will 

generate a separate 

work plan)

# of 

Unduplicated 

Volunteers 

# of Total 

Volunteers 

# of 

Volunteer 

Stations

Output 

Target

Outcome Outcome 

Instrument

Outcome 

Target

H4A. Number 

of individuals 

served

Tracking 

System

[Complete from 

the available 

Service Activities 

in the table 

alongside this 

output. For 

example, 

“Companionship” 

or “Respite 

Services”] 

[Identify how 

many 

unduplicated 

volunteers will 

have this as the 

area where 

he/she intends 

to make the 

most impact] 

[Identify 

how many 

volunteers 

in all will 

contribute to 

this work 

plan] 

[Identify 

how many 

stations 

will 

contribute 

to this 

work plan] 

[Estimate 

your 

target for 

the output 

you 

identified 

in Column 

A]

[ You may select 

either outcome H9A: 

Number of individuals 

who report having 

increased social 

support or improved 

capacity for 

independent living 

[OR] H14: Number of 

caregivers of older 

adults and individuals 

with disabilities who 

reported having 

increased social 

support ]

[Choose the 

option that 

best 

describes 

the tool you 

will use to 

measure the 

number of 

outputs 

achieved.]

[Estimate 

your 

target for 

the 

output 

you 

identified 

in 

Column 

A]

Total number of unduplicated volunteers in National Performance Measure Work Plans: [COMPLETE]_____________________

Update this as you complete work plans to reflect the cumulative number of unduplicated volunteers programmed into National Performance Measure Work 

Plans. For example, if this is the first work plan I have completed, and I have included 10 Unduplicated Volunteers in Column D, the value would be 10. If this is 

my second, and I have included 10 Unduplicated Volunteers in Column D in each work plan, it would be 20, and so on. 

Service Activity Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 

Output Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 
Outcome Instrument Description(s) 

[Complete on your own, using the prompts in the Notice, Appendix B, and the AmeriCorps Seniors Grant Application Instructions. Be sure to provide all the 

information requested.] 

Work Plan Development Worksheet Focus Area: OTHER COMMUNITY PRIORITIES Objective: OTHER COMMUNITY PRIORITIES 

Community Need:

[This section is required for Other Community Priorities Work Plans. See pg. 5 of Appendix B. AmeriCorps Seniors SCP National Performance Measures Instructions for more 

information.] 

A B C D E F G H I J

Output Output 

Instrument

Service Activity 

(each selected 

will generate a 

separate work 

plan)

# of Unduplicated 

Volunteers 

# of Total 

Volunteers 

# of Volunteer 

Stations

Output 

Target

Outcome Outcome 

Instrument

Outcome 

Target

[There is 

only one 

option 

here: 

Grantee 

met its 

target for 

community 

priority 

activity: 

Yes/No.]

This is not 

required 

for these 

work plans.

This is not 

required for 

these work 

plans.

[Identify how many 

unduplicated volunteers (no 

more than 30% of the total 

unduplicated volunteers) will 

have this as the area where 

he/she intends to make the 

most impact. These 

unduplicated volunteers do 

NOT count toward the total 

that result in national 

performance measure 

outcomes. They do count 

towards your total number 

of unduplicated volunteers]

[Identify 

how many 

volunteers 

in all will 

contribute 

to this 

work plan]

[Identify how 

many stations 

will contribute 

to this work 

plan]

[Estimate 

your target 

for the 

output you 

identified 

in Column 

A]

This is not 

required for 

these work 

plans.

This is not 

required for 

these work 

plans.

This is not 

required for 

these work 

plans.

Total number of unduplicated volunteers in National Performance Measure Work 

Plans: _ [COMPLETE]_________

The number of unduplicated volunteers you enter in this work plan SHOULD NOT be 

included in this total. It should reflect only the work plans you have completed 

previous, which contribute to National Performance Measures outcomes. 

Total number of unduplicated volunteers: _ [COMPLETE]_________

Add the number you put in Column D to the number you entered in the box to the 

left. This is the total number of unduplicated volunteers for your proposal.

Service Activity Description(s)

This is not required for these work plans.
Output Instrument Description(s)

This is not required for these work plans.

Outcome Instrument Description(s)

This is not required for these work plans.