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2012 AmeriCorps State and National

APPLICATION INSTRUCTIONS

State and National Competitive New and Continuation

including 

AmeriCorps Indian Tribes

AmeriCorps National Direct

AmeriCorps National Education Awards Program

AmeriCorps National Fixed Amount Grants

AmeriCorps States without Commissions

AmeriCorps Territories without Commissions 

State Commission AmeriCorps State

State Commission AmeriCorps State Fixed Amount Grants

State Commission Competitive Education Awards Program

Deadline: January 18, 2012

OMB Control #: 3045-0047 Expiration Date: 2/29/2012
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IMPORTANT NOTICE

These application instructions conform to the Corporation for National and Community 

Service’s online grant application system, eGrants. All funding announcements by the 

Corporation for National and Community Service (CNCS or the Corporation) are posted on

www.nationalservice.gov and www.grants.gov. 

Public Burden Statement: Public reporting burden for this collection of information is 

estimated to average 40 hours per submission, including reviewing instructions, gathering and 

maintaining the data needed, and completing the form. Comments on the burden or content of 

this instrument may be sent to the Corporation for National and Community Service, Attn: Amy 

Borgstrom, 1201 New York Avenue, NW, Washington, D.C. 20525. CNCS informs people who 

may respond to this collection of information that they are not required to respond to the 

collection of information unless the OMB control number and expiration date displayed on page 

one are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

Privacy Act Notice: The Privacy Act of 1974 (5 U.S.C § 552a) requires that the following 

notice be provided to you: The information requested on the AmeriCorps Application 

Instructions is collected pursuant to 42 U.S.C 12592 and 12615 of the National and Community 

Service Act of 1990 as amended, and 42 U.S.C. 4953 of the Domestic Volunteer Service Act of 

1973 as amended. Purposes and Uses - The information requested is collected for the purposes of 

reviewing grant applications and granting funding requests. Routine Uses - Routine uses may 

include disclosure of the information to federal, state, or local agencies pursuant to lawfully 

authorized requests. In some programs, the information may also be provided to federal, state, 

and local law enforcement agencies to determine the existence of any prior criminal convictions. 

The information may also be provided to appropriate federal agencies and Department 

contractors that have a need to know the information for the purpose of assisting the 

Department’s efforts to respond to a suspected or confirmed breach of the security or 

confidentiality or information maintained in this system of records, and the information disclosed 

is relevant and unnecessary for the assistance. Executive Summaries of all compliant 

applications received and applications of successful applicants will be published on the CNCS 

website as part of ongoing efforts to increase transparency in grantmaking. This is described in 

more detail in the Notice of Federal Funding Opportunity. The information will not otherwise be 

disclosed to entities outside of AmeriCorps and CNCS without prior written permission. Effects 

of Nondisclosure - The information requested is mandatory in order to receive benefits. 

Federal Funding Accountability and Transparency Act: Grant recipients will be required to 

report at www.FSRS.gov on all subawards over $25,000 and may be required to report on 

executive compensation for recipients and subrecipients. Recipients must have the necessary 

systems in place to collect and report this information. See 2 C.F.R. Part 170 for more 

information and to determine how these requirements apply.

Universal Identifier: Applications must include a Dun and Bradstreet Data Universal 

Numbering System (DUNS) number and register with the Central Contractor’s Registry 

(CCR). All grant recipients are required to maintain a valid registration, which must be renewed 

annually.
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TABLE OF CONTENTS

Important Notice ..............................................................................................................................2

New and Recompeting Programs.................................................................................................4

Application Resources...................................................................................................................4

Submitting Your Application in eGrants ....................................................................................5

I. Applicant Info ...................................................................................................................6

II. Application Info................................................................................................................6

III. Narratives..........................................................................................................................7

IV. Performance Measures....................................................................................................16

V. Documents ......................................................................................................................16

VI. Budget Instructions.........................................................................................................18

VII. Review, Authorize, and Submit......................................................................................20

VIII. Survey on Ensuring Equal Opportunity for Applicants (Optional) ................................20

Continuation Requests.................................................................................................................21

Tables

Table 1: Requirements in the AmeriCorps Regulations.................................................................5

Table 2: Match Requirements in the AmeriCorps Regulations....................................................18

ATTACHMENTS

These Attachments are Worksheets only. All information must be entered in eGrants.

A. SF-424 Facesheet 

 (eGrants Applicant Info and Application Info Sections).........................................................24

B. Service Categories (eGrants Performance Measures Section).................................................29

C. Performance Measure Instructions (eGrants Performance Measures Section)........................31

D. Detailed Budget Instructions....................................................................................................37

E. Budget Worksheet....................................................................................................................43

F. Detailed Budget Instructions for Fixed-Amount Grants..........................................................47

G. Fixed-Amount Budget Worksheet ...........................................................................................49

H. Budget Checklist......................................................................................................................50

I. Alternative Match Instructions ................................................................................................52

J. Survey on Ensuring Equal Opportunity for Applicants...........................................................54

K. Beale Codes and County-Level Economic Data......................................................................56

L. Assurances and Certifications (eGrants Authorize and Submit Section) ................................59

M. Beneficary Populations (eGrants Performance Measures Section ) ..............................67
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NEW AND RECOMPETING PROGRAMS

Application Resources

Dates: Applications are due to CNCS January 18, 2012 at 5:00 p.m. Eastern Time. Successful 

applicants will be notified by May 31, 2012.

If your proposed grant will be used to develop a program that will operate solely within one 

state, and you are not an Indian Tribe, you must apply through your state service commission for 

funding. The state service commission (commission) will provide you with the appropriate 

application materials and inform you of its application deadline.

A list of all State Service Commissions can be found here: 

http://www.americorps.gov/about/contact/statecommission.asp.

Commissions do not currently exist in American Samoa, the Commonwealth of the Northern 

Mariana Islands, South Dakota, and the U.S. Virgin Islands. We are accepting grant applications 

from organizations applying solely within these locales.

Please use these application instructions to apply directly to the Corporation for National and 

Community Service (CNCS) only if your proposed grant will be developing a multi-state 

AmeriCorps program, if you are an Indian Tribe applying for the Indian Tribe-specific funds, or 

if your program is located in a state or territory that does not have a commission. 

Indian Tribes have the option of applying through their local state commissions, or directly to 

CNCS. 

Please use these application instructions if you are a new or recompeting applicant applying for 

the following grants: State and National Competitive including Professional Corps, State and 

National Education Award Programs (EAPs), Full-time Fixed-amount grants, States and 

Territories without Commissions, and Indian Tribes. 

If you are submitting a request for continuation, please see the Continuation Instructions which 

begin on page 21.

Use these instructions in conjunction with the 2012 Notice of Federal Funding Opportunity 

(Notice), and the AmeriCorps Regulations, 45 CFR §§ 2520–2550. The Notice includes 

deadlines, eligibility requirements, submission requirements, maximum amount of funding 

per Member Service Year (MSY),1and other information that changes each year for all 

AmeriCorps grant programs. 

 

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One MSY is equivalent to at least 1700 service hours, a full-time AmeriCorps position. The CNCS cost per MSY 

is determined by dividing the CNCS share of budgeted grant costs by the number of MSYs requested in the 

application. It does not include childcare or the cost of the education award.
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The AmeriCorps regulations include pertinent information (see Table 1, below). The Notice can 

be found at http://www.americorps.org/for_organizations/funding/nofa.asp. The full regulations 

are available online at www.gpoaccess.gov/ecfr. 

Table 1: Requirements in the AmeriCorps Regulations

Topics Citation in the AmeriCorps Regulations

Member Service Activities §2520.20 - §2520.55

Prohibited Activities §2520.65

Tutoring Programs §2522.900-2522.950

Matching Funds §2521.35-2521.90

Member Benefits §2522.240-2522.250

Calculating Cost Per Member Service Year (MSY) §2522.485

Performance Measures §2522.500-2522.650

Evaluation §2522.500-2522.540 and §2522.700-2522.740 

Selection Criteria and Selection Process §2522.400-2522.475

If there is any inconsistency between the AmeriCorps regulations, the Notice, and the 

Application Instructions, the order of precedence is as follows:

1. AmeriCorps regulations 45 CFR §§ 2520–2550 take precedence over the

2. Notice of Federal Funding Opportunity, which takes precedence over the

3. Application Instructions.

New and Recompeting Applicants

Submitting Your Application in eGrants 

Dates: Applications are due January 18, 2012 at 5:00 p.m. Eastern Time. Successful applicants 

will be notified by May 31, 2012.

New applicants need to establish an eGrants account by accessing this link: 

https://egrants.cns.gov/espan/main/login.jsp and selecting ―Don’t have an eGrants account? 

Create an account.‖

In eGrants, before Starting Section I you will need to:

Start a new Grant Application

Select a Program Area (AmeriCorps)

Select a NOFA: 

AmeriCorps Indian Tribes FY 2012

AmeriCorps National Direct FY 2012

AmeriCorps National Education Awards Program FY 2012

AmeriCorps National Fixed Amount Grants FY 2012

AmeriCorps States without Commissions FY 2012 (South Dakota)

AmeriCorps Territories without Commissions FY 2011 (American Samoa, Northern

Mariana Islands, and the United States Virgin Islands)

Commission AmeriCorps State FY 2012

Commission AmeriCorps State Fixed Amount Grants FY 2012

Commission Competitive Education Awards Program FY 2012
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If you are from an Indian Tribe, Territory, or State without a Commission and are applying for a 

fixed-amount grant, please use the AmeriCorps National Fixed-Amount Grants eGrants NOFA.

Your application consists of the following components. Make sure to complete each section.

I. Applicant Info 

II. Application Info

III. Narratives

IV. Performance Measures

V. Documents

VI. Budget 

VII. Review, Authorize, and Submit

VIII. Survey on Ensuring Equal Opportunity for Applicants (Optional) 

I. Applicant Info

Information entered in the Applicant Info, Application Info, and Budget sections will populate 

the SF 424 Facesheet. If you are submitting your application in hard copy, you will find the 

SF 424 in Attachment A. 

Select Continuation/Renewal if you are recompeting (if you are in year three of a 

competitive three-year funding cycle). Select New only if you are applying for the first time,

have received formula funding only in the past, or are a former grantee (non-formula). 

Enter, or update the requested information in the fields that appear. The contact person needs 

to be the person who can answer questions about the application.

II. Application Info

In the Application Info Section enter:

Areas affected by your proposed program. Please include the two-letter abbreviation with 

both letters capitalized for each state where you plan to operate. Separate each two-letter 

state abbreviation with a comma. For city or county information, please follow each one with 

the two-letter capitalized state abbreviation.

Requested project period start and end dates. You may not request a program start date 

earlier than June 15. First-time grantees should not expect to start until late summer or early 

fall. The project period is three years. 

Indicate Yes or No if you are delinquent on any federal debt. If yes, send explanation as 

described in Section V.D.

State Application Identifier: Enter N/A.

The Application is Subject to Review by State Executive Order 12372 Process: This 

is pre-filled as ―No, this is not applicable.‖ 

If you plan to request a waiver of the volunteer leveraging requirement please select 

―Request a waiver‖ at the bottom of the screen. A pop-up screen will appear. Select a waiver 

type and enter your volunteer leveraging waiver request justification in the narrative field in 

2,000 characters or less.

Leave the box for ―Program Initiative‖ blank. 

The ―Estimated Funds Requested‖ box will be populated automatically after you complete 

the budget.
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III. Narratives

The narrative section of the application is your opportunity to convince reviewers that your 

project meets the selection criteria. Below are some general recommendations to help you 

present your project in a way the reviewers will find compelling and persuasive.

Lead from your program strengths and be explicit. Do not make the mistake of 

trying to stretch your proposed program description to fit each funding priority and 

special consideration articulated in the regulations or the Notice. 

Be clear and succinct. Reviewers are not interested in jargon, boilerplate, rhetoric, or 

exaggeration. They are interested in learning precisely what you intend to do, and 

how your project responds to the selection criteria presented below.

Avoid circular reasoning. The problem you describe should not be defined as the 

lack of the solution you are proposing.

Explain how. Avoid simply stating that the criteria will be met. Explicitly describe 

how the proposed project will meet the criteria.

Don’t make assumptions. Even if you have received funding from CNCS in the 

past, do not assume your reviewers know anything about you, your proposed 

program, your partners, or your beneficiaries. Avoid overuse of acronyms.

Use an impartial proofreader. Before you submit your application, let someone 

who is completely unfamiliar with your project read and critique the project narrative.

Follow the instructions and discuss each criterion in the order they are presented 

in the instructions. Use headings to differentiate narrative sections by criterion.

In eGrants, you will enter text for 

Executive Summary.

Rationale and Approach (Program Design).

Organizational Capability.

Cost Effectiveness and Budget Adequacy.

Evaluation Plan. 

You may not exceed 26 double-spaced pages for the Narratives, including the Executive 

Summary and Cover Page, as the pages print out from eGrants. Reviewers will not 

consider material submitted over the page limit, even if eGrants allows you to enter and 

submit text over the limit. From the Review and Submit page, print out your application 

prior to final submission to ensure it is not over the 26 page limit. This limit does not 

include the budget and performance measures.

Note: The Narratives Section also includes fields for Clarification Information, Amendment 

Justification, and Continuation Changes. Please enter N/A in these fields. They will be used at 

a later date to enter information for clarification following review, to request amendments 

once a grant is awarded, and to enter changes in the narrative in continuation requests. 

External and staff reviewers will assess your application against the selection criteria. The bullets 

that follow the criteria are recommendations on how to best respond to the criteria. To best 

respond to the criteria, we suggest that you include a brief discussion of each bullet if it pertains 

to your application.
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A. Executive Summary

Please provide a one-paragraph executive summary of your proposed program. This summary

must be one-half page or less. The summary should include who, what, where, when, and why: 

Who will be serving? Who will be served?

What will the AmeriCorps members do?

Where will the activity take place?

When does the project begin and end?

What is the expected outcome(s) of the project? 

You may fill in the blanks in the following template to complete your executive summary.

[Number of] AmeriCorps members will leverage an additional [number of leveraged volunteers, 

if applicable] to [what the members will be doing] in [where they will be working]. At the end of 

the [duration of project] period, [anticipated outcome of project]. This project will focus on the 

CNCS focus area of [Focus Area(s)]. The CNCS investment of $[amount of request] will be 

matched with $[amount of projected match]. 

CNCS will post these summaries on www.nationalservice.gov in the interest of transparency 

and Open Government.

B. Selection Criteria

Each application must clearly describe a project that will effectively deploy AmeriCorps 

members to solve a significant community problem. 

1. Rationale and Approach/ Program Design (50 percent)

In assessing Rationale and Approach/ Program Design, reviewers will examine the degree to 

which the applicant demonstrates how AmeriCorps members are particularly well-suited to 

solving the identified community needs.

Specifically, reviewers will assess the extent to which the applicant:

Provides persuasive evidence that the identified needs exist in the targeted 

community(ies). (5 points)

Describes the ways in which AmeriCorps members are a highly effective means to 

solving the identified community needs, including the unique value added by 

AmeriCorps. (15 points)

Describes how the interventions the AmeriCorps members and volunteers are or will be

engaged in are both evidence-based and will have a measurable community impact. The 

intervention is evidence-based if programs can demonstrate community impact and solve 

community problems through an evidence based approach (e.g. performance data, 

research, theory of change). (15 points) 

Describes the program components that enable the AmeriCorps members to have 

powerful service experiences that increase community impact and lead to continued civic 

participation and connectivity with other AmeriCorps and national service participants.

(10 points)
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Convincingly links four major elements: (1) the need(s) identified, (2) the intervention

that will be carried out by AmeriCorps members and community volunteers, (3) the ways 

in which AmeriCorps members are particularly well-suited to deliver the intervention, 

and (4) the anticipated outcomes. (5 points)

Recompeting grantees must describe their efforts and impact to date, and provide persuasive 

evidence that they should continue to be funded. If a new applicant is already working to meet 

the community need identified in the application, the applicant should describe how the proposed 

use of AmeriCorps members will add value, i.e., be more effective than what is currently being 

implemented, or enhance existing efforts. Include what the applicant’s efforts and impact have 

been to date.

In discussing how you will meet the criteria, please include your response to the following:

a. Need

Describe the community need(s) you will be working on. Why did you choose this need? Provide 

documentation of the extent/severity of the need in the target community. Describe the target 

community. Why did you select this population to be served? 

b. Value Added: AmeriCorps Member Roles and Responsibilities 

What will members do? Give examples of specific proposed member activities. Why are the 

members a highly effective means to solve the identified community need? What is the added 

value of the AmeriCorps members’ service? How many members are you requesting? What 

types of slots (service terms) are needed for these members? If you are requesting different slot 

types, explain how the different slot types align with your program design and activities.

c. Evidence-Based

Describe how the interventions the AmeriCorps members and volunteers will be engaged in are 

both evidence-based and will have a measurable community impact.

d. Member Experience

Describe the program components that enable the AmeriCorps members to have powerful 

service experiences that increase community impact and lead to continued civic participation and 

connectivity with other AmeriCorps and national service participants. Demonstrate how you will 

provide structured opportunities for participants to reflect on and learn from their service which 

will result in a quality member experience and promote a lifelong ethic of service and civic 

responsibility. Describe how your program will ensure that members are aware they are 

AmeriCorps members and identify as such to community members, partners, and the general 

public. Describe how you will connect your members with each other, with other AmeriCorps 

members and national service participants in the local communities in which they serve, with 

other AmeriCorps and national service participants in the state, and nationally. How will your 

program foster a sense of connection and identity with the AmeriCorps brand?

e. Overall Picture

How does your program design link: (1) the need(s) identified, (2) the intervention that will be 

carried out by AmeriCorps members and community volunteers, (3) the ways in which 
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AmeriCorps members are particularly well-suited to deliver the intervention, and (4) the 

anticipated outcomes?

f. AmeriCorps Member Selection, Training, and Supervision

Describe your plans for recruiting members for your program. Describe how members will be 

included from the local communities to be served by your program. If you will be recruiting and 

engaging traditionally underrepresented populations, please describe the organization’s history 

with working with those populations or how it will ensure success if this is a new population 

being recruited. Underrepresented populations may include new Americans, low-income 

individuals, rural residents, older Americans, veterans, members of faith-based organizations, 

communities of color, Native Americans and people with disabilities. 

Describe your plan for orienting members to AmeriCorps, the community they are serving, their 

placement site, and to the service they will perform. Describe how you will ensure that training 

provided to members will prepare members to perform all the activities they will engage in 

during their term of service. Describe, as necessary, the ongoing training provided to members 

throughout their terms. What are the anticipated training topics and the timeline for member 

training? How and when will you ensure that members are aware of prohibited activities? What, 

if any, program design and/or member or staff training changes will be made to ensure a positive 

member experience for underrepresented populations?

Describe your plan for supervising members, and how it ensures that members will receive 

adequate support and guidance throughout their terms. Who will supervise the AmeriCorps 

members? Describe how supervisors are selected and trained. Describe how your program 

provides training, oversight, and support to supervisors.

g. Outcome: Performance Measures 

What is the overall change you want to see by the end of the three-year grant cycle? What 

demonstrable impact will your program have? How will you measure impact? How will you 

report on this on an annual basis? How did you determine your performance measure targets?

Current Grantees Only: What impact has your program had? How successful have you been in 

tackling the identified problem?

h. Volunteer Generation 

Describe how the proposed program will recruit volunteers to expand the reach/impact in the 

community. How will volunteers help meet the identified community needs and what will be 

their role(s)? What role will AmeriCorps members have in volunteer recruitment and 

management? If you are requesting a waiver of the requirement to recruit or support volunteers 

(see 45 CFR § 2520.35), enter the rationale in the waiver justification field (see p. 6).

i. Tutoring Programs Only

If you are proposing to operate a tutoring program, describe how your process complies with 

AmeriCorps requirements for member tutoring qualifications. Members who tutor must have a 

high school diploma, and successfully complete high-quality, research-based pre- and in-service 
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training for tutors. This requirement does not apply to a member enrolled in a secondary school 

who is providing tutoring through a structured, school-managed cross-grade tutoring program. 

Describe how your strategy for training members complies with AmeriCorps requirements for 

member tutor training that is high quality and research based, consistent with the instructional 

program of the local agency and with state academic content standards [section 1111 of the 

Elementary and Secondary Education Act of 1965 (20 U.S.C. 6311)], includes appropriate 

member supervision by individuals with expertise in tutoring, and provides specialized preservice and in-service training consistent with the activities the member will perform. 

2. Organizational Capability (25 percent)

Reviewers will assess the extent to which:

The organization has the experience, staffing, and management structure to plan, 

implement and evaluate the proposed program. 

The organization has secured, or describes an effective plan for securing, the financial 

and in-kind resources necessary to support program implementation and to demonstrate 

community stakeholder support. 

The organization has the ability and structure to ensure its and its subgrantees and/or 

service locations’ compliance with AmeriCorps rules and regulations including

prohibited activities.

Multi-state applicants have consulted with state and territory service commissions to 

ensure non-duplication and coordination of CNCS resources. 

Current or previous AmeriCorps grantees filled the member positions they were awarded 

and retained the AmeriCorps members they enrolled or have provided an explanation for 

less than 100% enrollment and retention.

Current or previous AmeriCorps grantees have met performance targets and 

demonstrated compliance with grant terms and conditions.

In discussing how you will meet the criteria, please include your response to the following:

a. Organizational Background and Staffing

Provide the organization’s mission and a brief history. Identify the primary and secondary 

contacts for the grant application. Describe your organization’s prior experience administering 

AmeriCorps grants or other federal funds. Describe your organization’s experience raising funds 

to support service activities and initiatives. Please list all sources of organizational funding in 

this section, and what percent the proposed AmeriCorps project represents in your budget. If you 

have received support from CNCS during the last five years, please specify what type of support 

you received. What percentage of your total funding comes from CNCS?

Explain your organization’s management structure and how the board of directors (if applicable), 

administrators, and staff members will support your program.

If you already operate an AmeriCorps program, describe how it is integrated and supported 

within your organization. Provide evidence that you have managed the program well, have 

performed satisfactorily, and have a record of compliance and responsiveness.
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Who will staff the AmeriCorps program and what is their specific role? What is their relevant 

experience? If positions are currently vacant, please describe the desired qualifications for each 

open position. What are your plans for providing financial and programmatic orientation; 

training and technical assistance; and monitoring program and service sites for compliance? 

b. Sustainability 

Outline your plans for ensuring that the impact of your program in the community is sustainable 

beyond the presence of federal support. For example, you might describe how your community 

relationships will lead to community investment in the program’s continued operation; how you 

will diversify your funding sources to include a wide range of stakeholders (such as state, local, 

and private sector funding); how your strategies for recruiting and supporting volunteers will 

sustain member activities after your AmeriCorps grant ends; or how the community will 

maintain your project once it is completed.

Who are your community stakeholders and partners? How are they involved in planning and 

implementing the proposed program? 

c. Compliance and Accountability

How will your organizational ensure compliance with AmeriCorps rules and regulations at the 

grantee, subgrantee, and service site locations (if applicable)? How will your organization 

prevent and detect compliance issues in general and specifically as it relates to prohibited 

activities? How will your organization hold itself, subgrantees, and service site locations (if 

applicable) accountable if instances of risk or noncompliance are identified? 

Multi-state Applicants Only

d. Consultation with State Commissions

Describe the manner and extent to which you consulted with the State Commission in the states 

in which you plan to operate.

Current Grantees and Former Grantees Only

e. Enrollment and Retention

Enrollment: If you enrolled less than 100% of slots received during your last full year of 

program operation, provide an explanation, and describe your plan for improvement. Enrollment 

rate is calculated as slots filled plus refill slots filled divided by slots awarded.

Retention: If you were not able to retain all of your members during your last full year of 

program operation, provide an explanation, and describe your plan for improvement. While we 

recognize retention rates may vary among equally effective programs depending on the program 

model, we expect grantees to pursue the highest retention rate possible. Retention rate is 

calculated as the number of members exited with award (full or partial award) divided by the 

number of members enrolled.

f. Performance Targets and Demonstrated Compliance

Performance Targets: Describe your performance against objectives during your last full year of 

program operation. If you did not meet performance targets, provide an explanation and describe 

your plan for improvement.
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Demonstrated Compliance: Describe any compliance issues and areas of weakness/risk 

identified during your last full year of program operation at your organization, your subgrantees, 

service sites (if applicable). If you, your subgrantees, and service sites (if applicable) had

compliance or areas of weakness/risk identified, provide an explanation and describe the 

corrective action taken and your plan for improvement.

Multi-Site Applicants Only

g. Operating Sites and Member Service Sites

Identify your proposed operating sites and member service sites. Describe your process for 

selecting operating and service sites and ensuring they have adequate programmatic and financial 

capabilities to succeed. How will your site selection process incorporate the criteria required by 

the AmeriCorps regulations 45 CFR §2522.475 (quality, innovation, sustainability, quality of 

leadership, past performance, community involvement), and the special considerations found in 

45 CFR §2522.450 (program models, program activities and programs supporting distressed 

communities)? What are your current or previous programmatic and funding relationships with 

the sites? If member service sites are not yet known, describe your timeline for selecting service 

sites.

h. Special Circumstances

In applying the organizational capability criteria, reviewers may also take into account the 

following circumstances of individual organizations: The age of your organization and its rate of 

growth; and whether your organization serves a resource-poor community, such as a rural or 

remote community, a community with a high poverty rate, or a community with a scarcity of 

philanthropic and corporate resources. In considering applications, CNCS shall ensure the 

equitable treatment of applicants from urban areas, applicants from rural areas, applicants of 

diverse sizes (as measured by the number of participants served), applicants from States, and 

applicants from national nonprofit organizations.

If you feel that any of the circumstances stated above have an impact on your 

organizational capability that has not already been discussed, please describe the 

circumstance and how it affects your organizational capacity.

3. Cost Effectiveness and Budget Adequacy (25 percent)

For cost-reimbursement grants, reviewers will assess the extent to which:

The budget is clear, reasonable, cost-effective, and in alignment with the program 

narrative. 

The requested funds do not exceed the maximum cost per Member Service Year (MSY), 

or for existing programs, have not increased over previous years. The amount requested 

is a competitive factor in the selection process. 

For EAPs and Full-time Fixed-amount grants, reviewers will assess:

The applicant’s demonstrated understanding of total program cost and capacity to raise the 

additional resources beyond the fixed-amount provided by CNCS.
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The amount requested per member. Fixed-amount applicants are encouraged to request 

less than the full maximum amount allowed per MSY. The amount requested is a 

competitive factor in the selection process. 

a. Cost Effectiveness 

The cost per MSY is determined by dividing the CNCS share of budgeted grant costs by the 

number of MSYs requested in the application. It does not include childcare or the cost of the 

education award. One MSY is equivalent to at least 1700 service hours, a full-time AmeriCorps 

position. The cost per MSY will be automatically calculated once you enter your budget in 

eGrants.

The maximum allowable cost per MSY is published each year in the Notice. Cost effectiveness 

will be evaluated by analyzing cost per MSY in relation to your program design. If you request 

above the maximum, please justify. This is rarely approved.

Demonstrate how your program has or will obtain diverse resources for program 

implementation. Indicate how much funding your program needs from non-Corporation sources 

to support the project. Indicate the non-CNCS resource commitments (in-kind and cash) that you 

have obtained to date and the sources of these funds. Indicate what additional commitments you 

plan to secure, and how you will secure them. 

b. Current Grantees Only: 

Describe the extent to which you are increasing your share of costs to meet or exceed program 

goals, or the extent to which you are proposing deeper impact or broader reach without a 

commensurate increase in Federal funds.

Cost per MSY: Recompeting grantees requesting a higher cost per MSY than in the previous 

year must include a compelling rationale for this increased cost. This applies even if the 

increased cost per MSY is less than the maximum or if the increase is due to increased costs

associated with the grant.

c. Special Circumstances

In applying the cost-effectiveness criteria, CNCS may take into account the following 

circumstances of individual programs: program age, the extent to which your program expands 

to new sites; whether your program or project is located in a resource-poor community, such as a 

rural or remote community, a community with a high poverty rate, or a community with a 

scarcity of corporate or philanthropic resources; whether your program or project is located in a 

high-cost, economically distressed community, measured by applying appropriate Federal and 

State data; and whether the reasonable and necessary costs of your program or project are higher 

because they are associated with engaging or serving difficult-to-reach populations, or achieving 

greater program impact as evidenced through performance measures and program evaluation.

If you feel that any of the circumstances stated above have an impact on your 

organizational capability that has not already been discussed, please describe the 

circumstance and how it affects your organizational capacity.
15

d. Budget Adequacy 

Unless you are applying for an EAP or Full-time Fixed-Amount grant, discuss the adequacy of 

your budget to support your program design including how it is sufficient to support your 

program activities and desired outputs and outcomes. Please explain how the cost of criminal 

history checks and FBI checks, if applicable, are covered if they are not included in the budget.

e. EAPs and Full-time Fixed-Amount Applicants (including Professional Corps Fixed 

Amount) Only

The extent to which a current grantee is increasing its share of costs will not be considered in 

assessing a fixed-amount application. However, all other indicators described under Cost 

Effectiveness and Budget Adequacy apply and the section will be weighted 25% of the total 

application. 

Discuss how you will raise the additional resources you will need to manage and operate an 

AmeriCorps program. Identify the total amount you have budgeted to operate the program, 

including the fixed amount from the CNCS and grantee share and how your program determined 

that amount. Keep in mind that full-time AmeriCorps program costs include expenditures for the 

AmeriCorps living allowance, health care, and criminal history checks. 

Education Award Programs are not required to pay living allowances or cover health care for 

less-than-full-time members, but must conduct criminal history checks. You will not be required 

to track or report on your expenditures. However, you must demonstrate that you have planned 

for total costs. Reviewers will assess the adequacy of your plan to secure resources to support 

your program design.

C. Evaluation Summary or Plan 

If you are competing for the first time, please enter N/A in the Evaluation Summary or Plan field 

since it pertains only to recompeting grantees. If you are recompeting for AmeriCorps funds for 

the first time you must submit a summary of your evaluation efforts or plan to date in the 

Evaluation Summary or Plan field in eGrants. If you are recompeting for a subsequent time, you 

must submit your evaluation report according to the instructions in V. E., below. An evaluation 

report may be submitted in place of an evaluation plan. 

Your evaluation requirements differ depending on the amount of your grant, as described in the 

AmeriCorps Regulations, Section 2522.710:

If you are State and National grantee (other than an Education Award Program grantee), and 

your average annual CNCS program grant is $500,000 or more, you must arrange for an 

external evaluation of your program, and you must submit the evaluation with any 

application to CNCS for competitive funds as required in §2522.730 of this subpart.

If you are State and National grantee whose average annual CNCS program grant is less than 

$500,000, or an Education Award Program grantee, you must conduct an internal or an 

external evaluation of your program, and you must submit the evaluation with any 

application to CNCS for competitive funds as required in §2522.730 of this subpart.

A formula program will be considered a recompeting application, if it satisfies the CNCS

definition of ―same project,‖ below, and has been funded in formula for at least one three-year
16

cycle. If your project satisfies the definition of same project, and you have completed one threeyear cycle, you will be required to submit an evaluation plan, summary, or evaluation report 

when you recompete for the first time. If your project does not satisfy the definition, it will be 

considered new and will not be required to submit an evaluation plan, summary, or completed 

evaluation.

Two projects will be considered the same if they:

Address the same issue areas.

Address the same priorities.

Address the same objectives.

Serve the same target communities and population.

Utilize the same sites.

Use the same program staff and members.

D. Amendment Justification

Enter N/A. This field will be used if you are awarded a grant and need to amend it. 

E. Clarification Information

Enter N/A. This field will be used to enter information that requires clarification in the postreview period. Please clearly label new information added during clarification with the date.

F. Continuation Changes

Enter N/A. This field will be used to enter changes in your narratives in your continuation 

requests. 

IV. Performance Measures

All applicants must submit performance measures with their application. See Attachment C for 

instructions for entering performance measures. Applicants are encouraged to select performance 

measures from Tier 1, 2, 3. 

For more information about Performance Measures go to: 

http://www.nationalserviceresources.org/star/ac

For more information about the National Performance Measures go to:

http://www.nationalserviceresources.org/national-performance-measures/home.

V. Documents 

In addition to the application submitted in eGrants, you are required to provide your evaluation, 

labor union concurrence (if necessary – see B., below) and a federally-approved indirect cost 

agreement (if budgeted by multi-state applicants, states and territories without commissions, and 

Tribes only) in hard copy or e-mail, as part of your application. After you have submitted the 

documents, change their status in eGrants from the default ―Not Sent‖ to the applicable status 

―Sent,‖ ―Not Applicable,‖ or ―Already on File at CNCS.‖. 

A. Evaluation
17

Submit any completed evaluation plan or report as described in E., below. Select Evaluation and 

select ―Sent‖ once you have submitted a completed evaluation plan or report. If an evaluation is 

required, you must submit a copy at the time of application even if you think CNCS may already 

have it on file.

B. Labor Union Concurrence

1) If a program applicant: 

a) Proposes to serve as the placement site for AmeriCorps members; and

b) Has employees engaged in the same or substantially similar work as that proposed to 

be carried out by AmeriCorps members; and

c) Those employees are represented by a local labor organization, then the application 

must include the written concurrence of the local labor organization representing 

those employees. Written concurrence can be in the form of a letter or e-mail from the 

local union leadership.

2) If a program applicant:

a) Proposes to place AmeriCorps members at sites where they will be engaged in the 

same or substantially similar work as employees represented by a local labor 

organization, then the applicant must submit a written description of how it will 

ensure that:

i) AmeriCorps members won’t be placed in positions that were recently occupied by 

paid staff 

ii) No AmeriCorps member will be placed into a position for which a recently 

resigned or discharged employee has recall rights as a result of a collective 

bargaining agreement, from which a recently resigned or discharged employee 

was removed as a result of a reduction in force, or from which a recently 

resigned/discharged employee is on leave or strike.

For the purposes of this section, ―program applicant‖ includes any applicant to CNCS or a State 

Commission, as well as any entity applying for assistance or approved national service positions 

through a CNCS grantee or subgrantee.

If either 1) or 2) above applies to you, please select ―Enter New,‖ name the new document 1) 

―Labor Union Concurrence,‖ or 2) ―Displacement Assurance‖ and select ―Sent.‖ 

C. Federally-approved Indirect Cost Agreement

Multi-state, states and territories without commissions, and Indian Tribes applicants that include 

a federally approved indirect cost rate amount in their budget must submit the approved indirect 

cost rate agreement to americorpsgrants@cns.gov at the same time they submit their application.

D. Delinquent on Federal Debt

Any applicant that checks Yes to the question on federal debt delinquency must submit a 

complete explanation.

E. Submission Instructions for Evaluations, Labor Union Concurrence, and Indirect Cost 

Rate Agreements
18

Please submit the required documents to americorpsgrants@cns.gov. This information must be 

received at CNCS by 5 p.m. Eastern Time on the deadline

Or, you may send hard copy information to: 

Corporation for National and Community Service

ATT: AmeriCorps State and National

1201 New York Avenue NW

Washington, DC 20525

Please use an alternative service to the U.S. Postal Service to send hard copy. U.S. Postal Service 

deliveries to government agencies often are delayed and sometimes damaged due to security 

measures. Attach a hard copy of the program’s SF424 Facesheet to each document so that we 

know which application corresponds to each document. 

VI. Budget Instructions 

For Fixed-Amount grants, including EAPs: Use the Budget Instructions for Fixed-Amount 

applicants (Attachment F) and the Budget Worksheet (Attachment G) to prepare your 

budget. 

A. Match Requirements

Program requirements, including requirements on match are located in the AmeriCorps 

regulations and summarized below. 

Table 2: Match Requirements in the AmeriCorps Regulations

Competition Match Requirement

State and National Competitive including Professional 

Corps, States and Territories without Commissions, 

Indian Tribes 

Minimum grantee share is 24% of program costs for the 

first three years. Overall grantee share of total program 

costs increases gradually beginning in Year 4 to 50% by 

the tenth year of funding and any year thereafter.

State and National EAP Fixed-Amount Grants There are no specific match requirements for fixedamount grants. Grantees pay all program costs over $800 

per MSY provided by CNCS.

Professional Corps Fixed-Amount Grants There are no specific match requirements for fixedamount grants. Grantees pay all program costs over the 

$2,000 per MSY provided by CNCS.

Full-time Fixed-Amount Grants There are no specific match requirements for fixedamount grants. Grantees pay all program costs over the 

$13,000 per MSY provided by CNCS

Grantees are required to meet an overall matching rate that increases over time. You have the 

flexibility to meet the overall match requirements in any of the three budget areas, as long as 

the minimum match of 24% for the first three years, and the increasing minimums in years 

thereafter, are maintained. See 45 CFR §§ 2521.35–2521.90 for the specific regulations.

If you are applying for the first time, you must match with cash or in-kind contributions at 

least 24% of the project’s total Operating Costs (Section I) plus Member Costs (Section II) 

plus Administrative Costs (Section III). If you are recompeting, please see 45 CFR 2521.40-

2521.95 for the match schedule. 
19

The acceptable sources of matching funds are federal, state, local, private sector, and/or other 

funds in accordance with applicable AmeriCorps requirements. 

In Section III of the budget, enter a brief description of the source of match. Identify each 

match source separately. Include dollar amount, the match classification (cash, in-kind, or 

Not Available) and the source type (Private, State/Local, Federal, Other or Not Available),. 

Define all acronyms the first time they are used. 

See Attachment I for instructions for applying for the Alternative Match Schedule.

Note: The CNCS legislation permits the use of non-CNCS federal funds as match for the grantee 

share of the budget. Please discuss your intention of using federal funds to match an AmeriCorps 

grant with the other agency prior to submitting your application. Section 121(e)(5) of the 

National Community Service Act requires that grantees that use other federal funds as match for 

an AmeriCorps grant report the amount and source of these funds to CNCS. If you use other 

federal funds as match, you must ensure you can meet the requirements and purpose of both 

grants. The Federal Financial Report (FFR) will be used to collect the federal match data. 

Grantees that use federal funds as match will be required to report the sources and amounts on 

the FFR.

B. Preparing Your Budget

Your proposed budget should be sufficient to allow you to perform the tasks described in your 

narrative. Reviewers will consider the information you provide in this section in their assessment 

of the Cost-Effectiveness and Budget Adequacy selection criterion. 

Follow the detailed budget instructions in Attachment D to prepare your budget. We recommend 

that you prepare your budget in the same order as indicated in the Budget Worksheets in 

Attachments D and E. 

As you enter your detailed budget information, eGrants will automatically populate a budget 

summary and budget narrative report. Prior to submission be sure to review the budget checklist 

(Attachment H) to ensure your budget is compliant. In addition, eGrants will perform a limited 

compliance check to validate the budget. If it finds any compliance issues you will receive a 

warning and/or error messages. You must resolve all errors before you can submit your budget.

As you prepare your budget:

All the amounts you request must be defined for a particular purpose. Do not include 

miscellaneous, contingency, or other undefined budget amounts.

Itemize each cost and present the basis for all calculations in the form of an equation.

Do not include unallowable expenses, e.g., entertainment costs (which include food and 

beverage costs) unless they are justified as an essential component of an activity.

Do not include fractional amounts (cents).

Please refer to the relevant OMB Circulars on allowable costs for further guidance. The OMB 

circulars are online at www.whitehouse.gov/OMB/circulars.

A-21 - Cost Principles for Educational Institutions, 2 CFR 220

A-87 - Cost Principles for State, Local, and Indian Tribal Governments, 2 CFR 225
20

A-122 - Cost Principles for Non Profit Organizations, 2 CFR 230

Programs must comply with all applicable federal laws, regulations, and OMB circulars for grant 

management, allowable costs, and audits, including providing audits to the A-133 clearinghouse 

if expending over $500,000 in federal funds, as required in OMB Circular A-133. 

VII. Review, Authorize, and Submit

eGrants requires that you review and verify your entire application before submitting, by 

completing the following sections in eGrants:

Review

Authorize

Assurances

Certifications

Verify

Submit

Read the Authorization, Assurances, and Certifications carefully (Attachment L). The person 

who authorizes the application must be the applicant’s Authorized Representative or his/her 

designee and must have an active eGrants account to sign these documents electronically. An 

Authorized Representative is the person in your organization authorized to accept and commit 

funds on behalf of the organization. A copy of the governing body’s authorization for this 

official representative to sign must be on file in the applicant’s office.

Be sure to check your entire application to ensure that there are no errors before submitting it. 

eGrants will also generate a list of errors if there are sections that need to be corrected prior to 

submission when you verify the application. If someone else is acting in the role of the 

applicant’s authorized representative, that person must log into his/her eGrants account and 

proceed with Authorize and Submit. After signing off on the Authorization, Assurances, and 

Certifications, his/her name will override any previous signatory that may appear and show on 

the application as the Authorized Representative.

Note: Anyone within your organization who will be entering information in the application at 

any point during application preparation and submission in the eGrants system must have 

their own eGrants account. Individuals may establish an eGrants account by accessing this link: 

https://egrants.cns.gov/espan/main/login.jsp and selecting ―Don’t have an eGrants account? 

Create an account.‖

VIII. Survey on Ensuring Equal Opportunity for Applicants (Optional)

CNCS and other federal agencies are collaborating with the White House Office of Faith-Based

and Community Initiatives to conduct a survey of organizations that apply for federal funding. 

The purpose of this voluntary information collection is to compile statistics on the types of 

organizations that apply to CNCS for funds, such as number of employees, budget size, and selfidentification as a faith-based/religious organization or a non-religious community-based 

organization. 
21

This form is for applicants that are nonprofit private organizations, not including private 

universities. All information from the attached survey will be confidential and the responses will 

be aggregated in a summary report. Information provided on your form will not be released and 

will not be considered in any way in making funding decisions. If you are submitting a hard copy 

application, the form can be found in Attachment J.

You may complete the survey while preparing your application or after submitting your 

application.

1. To complete the survey while preparing your application, go to the Main Menu, select Enter 

Survey on Ensuring Equal Opportunity, provide the requested information and submit. 

2. If you submit your grant application without completing the survey, a pop-up box will appear 

and ask you if you would like to complete the survey. You may select Yes, No, or Remind 

Me Later. If you select Remind Me Later, you will be asked to fill in the survey next time 

you attempt to submit an application to the Corporation for National and Community 

Service. 

CONTINUATION REQUESTS

The following instructions for submitting a continuation request apply only to programs that are 

currently in their first or second year of operation within a three-year grant cycle. If your 

program is currently in the final year of its grant cycle, you must apply using the application 

instructions for new and recompeting programs. In addition, if you are in year two or three of a 

cost-reimbursement grant three-year cycle you need to submit a new application to participate in 

the fixed-amount pilot; you cannot continue your existing three-year project period and switch 

from cost-reimbursement to fixed-amount. CNCS reserves the right to consider your 

continuation request if your fixed-amount application is not funded.

Additional funding is contingent upon satisfactory performance, a grantee’s demonstrated 

capacity to manage a grant and comply with grant requirements, and availability of 

Congressional appropriations. CNCS reserves the right to adjust the amount of an additional 

grant award in subsequent years, or elect not to continue funding, based on these bases.

When to Submit Your Continuation Request:

The date for the submission of continuation requests is January 18, 2012 at 5:00 p.m. Eastern 

Time. 

How to Submit Your Continuation Request: 

Submit your continuation request in eGrants. 

Click Continuation/Renewal on your eGrants home page. You will be shown a list of grants 

that are eligible to be continued. Select the grant you wish to continue. Make sure you select 

the correct one. Do not start a new application. The system will copy your most recently 

awarded application. 

Edit your continuation application as directed in the continuation request instructions below. 

When you have completed your work, click the SUBMIT button. 
22

Be sure you also review the Notice when preparing your request. If you have questions about the 

content of your continuation request, please contact your Program Officer. If you experience 

problems using eGrants, contact the eGrants Help Desk at (888) 677-7849 or (202) 606-

7506, or email at egrantshelp@cns.gov.

What to Include in Your Continuation Request:

I. Applicant Info and Application Info 

Update the Applicant Info and Application Info Sections in eGrants if necessary. Note in the 

Continuation Changes field that you have updated the Applicant Info or Application Info 

Section(s). 

II. Narrative (Narratives Section)

Your original application will appear in the Executive Summary and in the narrative sections 

Rationale and Approach, Organizational Capability, Cost-Effectiveness and Budget Adequacy, 

Evaluation Summary or Plan, Amendment Justification, Clarification Information, and 

Continuation Changes, as appropriate. 

Do not enter continuation changes in the original narrative fields. If you are not proposing 

changes to your continuation request, simply leave your original narrative as it is, and enter No 

Changes in the Continuation Changes field.

If you have changes in any of these areas, please document them in the Continuation 

Changes field in eGrants. Clearly differentiate Year 2 and Year 3 continuation changes by 

using headings that label these as such. Continuation changes may include, but are not limited to:

New site locations.

Expansion to new sites, including the need that will be met in expansion communities, 

activities of expansion members, and organizational capacity to support the expansion.

Any changes in the budget.

Any increase in requested cost per MSY. This applies even if the increased cost per MSY 

is less than the maximum or if the increase is due to increased costs set by CNCS.

Plans for improving enrollment, retention, or other compliance issues. If you enrolled less 

than 100% of slots received during your last full year of program operation, provide an 

explanation, and describe your plan for improvement in the Continuation Changes field. 

If you were not able to retain all of your members during your last full year of program 

operation, provide an explanation, and describe your plan for improvement in the Continuation 

Changes field. We recognize retention rates may vary among equally effective programs 

depending on the program model. We expect grantees to pursue the highest retention rate 

possible. 

If you are requesting to conduct new activities or additional MSYs, these also need to be 

reflected in the budget and the performance measures. The page limit for the Continuation 

Changes field is 6 pages, as the pages print out from eGrants.
23

For Multi-state Continuations: Describe the manner and extent to which you consulted with 

the State Commission in the states in which you plan to operate.

III. Performance Measures (Performance Measures Section) 

Your performance measures are copied from your previous year’s application into your 

continuation request. If you made changes to your program, such as adding or changing grantfunded activities, or requesting additional slots or MSYs, you may need to revise your 

performance measures, To revise performance measures, ―View/Edit‖ the performance measures 

that copy over from your original application, or add new performance measures. Note in the 

Continuation Changes field that you have updated your performance measures.

IV. Budget (Budget Section)

Your budget from the previous year’s application is copied into your continuation request so you 

can make the necessary adjustments. Revise your detailed budget for the upcoming year. 

Incorporate any required CNCS increases, such as an increase to the member living allowance 

into your budget. Justify any increases not required by CNCS. CNCS expects that the Cost per 

MSY for continuation applicants will decrease or remain the same. Any increase in Cost per 

MSY must be justified in the Continuation Changes field.

Source of Match

In the ―Source of Match‖ field that appears at the end of Budget Section III, enter a brief 

description of the Source of Match, the amount, the match classification (Cash, In-kind, or Not 

Available) and Match Source (State/Local, Federal, Private, Other or Not Available) for your 

entire match. Define any acronyms the first time they are used.

V. Increasing Grantee Overall Share of Total Budgeted Costs 

Grantees are required to meet an overall matching rate that increases over time. You have the 

flexibility to meet the overall match requirements in any of the three budget areas, as long as the 

minimum match of 24% for the first three years, and the increasing minimums in years 

thereafter, are maintained. See 45 CFR §§ 2521.35–2521.90 for the specific regulations.

See Attachment I for instructions for applying for the Alternative Match Schedule.
24

ATTACHMENT A: Facesheet Instructions 

(eGrants Applicant Info and Application Info Sections)

Modified Standard Form 424 (Rev. 11/02 to conform to eGrants)

This form is required for applications submitted for federal assistance. 

Item #

1. Filled in for your convenience.

2. Self-explanatory.

3. 3. a. and 3. b. are for state use only (if applicable).

4. Item 4. a: Leave blank.

Item 4. b: If you are a recipient in year 2 or 3 of an already-awarded grant, enter the grant 

number, otherwise, leave blank.

5. Enter the following information:

a. The complete name of the organization that will be legally responsible for the grant, not the 

name of the organizational unit within the legally responsible organization. (For example, 

indicate ―National University‖ instead of ―Liberal Arts Department.‖)

b. Your organization’s DUNS number (received from Dun and Bradstreet). This is a required 

field. Please see the Notice for instructions on how to obtain a DUNS number.

c. The name of the primary organizational unit that will undertake the assistance activity, if 

different from 5. a.

d. Your organization’s complete address with the 9 digit ZIP+ 4 code. 

e. The name and contact information of the project director or other person to contact on matters 

related to this application. 

6. Enter your Employer Identification Number (EIN) as assigned by the Internal Revenue Service.

7. Item 7. a.: Enter the appropriate letter in the box.

Item 7. b.: Please enter the characteristic(s) that best describe your organization.

K-12 Education Non-Profit Organizations

1 School (K-12) 11 Community-Based Organization 

2 Local Education Agency 12 Faith-Based Organization

3 State Education Agency 13 Chamber of Commerce/ Business Association

14 Community Action Agency/ Program

Higher Education 15 Service/Civic Organization

4 Vocational/Technical College 16 Volunteer Management Organization

5 Community College 17 Self-Incorporated Senior Corps Project

6 2-year College 18 Statewide Association

7 4-year College 19 National Non-Profit (Multistate) 

8 Hispanic Serving College or University 20 Local Affiliate of National Organization

9 Historically Black College or University 21 Tribal Organization (Non-government) 

10 Tribally Controlled College or University 22 Other Native American Organization

Government

23 Local Government-Municipal 28 Other State Government 

24 Health Department 29 Tribal Government Entity

 25 Law Enforcement Agency 30 Area Agency on Aging

 26 Governor’s Office 31 U.S. Territory 

27 State Commission/Alternative Administrative Entity
25

8. Check the appropriate box for type of application and enter the appropriate letter(s) in the lower 

boxes:

Check ―New‖ if your organization has never held a competitive AmeriCorps State or 

National grant before. If your organization had a state formula grant, check ―New.‖

Check ―New Application/Previous Grantee‖ if your organization has held an AmeriCorps 

State or National grant in the past and this application is for a new grant.

Check ―Continuation‖ if you are a grantee applying for an additional year of funding within 

an existing multi-year grant project period. AmeriCorps State and National grants are 

typically awarded for three-year periods.

 

9. Filled in for your convenience.

10. Use the following list of CFDA (Catalog of Federal Domestic Assistance) numbers for the 

applicable program listing, or other source if so instructed in the Notice: 94.006 AmeriCorps State 

and National.

11. Enter the project title. 

a. When applying for a ―Continuation‖ or ―Amendment‖ applicants should use the same title as 

used for their existing grant program. When applying as a ―New Applicant/Previous Grantee‖ 

if the application is for re-funding of a previous grant program, use the same title as was used 

in the prior grant program if appropriate (i.e., if the program is unchanged).

b. Enter the name of the program initiative, if any, as provided in the instructions corresponding 

to the Notice for which you are applying; otherwise, leave blank.

12. List only the largest political entities affected (e.g., counties, and cities). Please include the twoletter abbreviation with both letters capitalized for each state where you plan to operate. Separate 

each two letter state abbreviation with a comma. For city or county information, please follow 

each one with the two-letter capitalized state abbreviation.

13. (See item 8) ―New‖ application or ―New application/previous grantee:‖ Enter the dates for the 

proposed three-year project period. ―Continuation‖ or ―Amendment‖ application: Enter the dates 

of the approved three-year project period.

Performance Period: this appears only in eGrants, and is for the use of staff only.

14. Leave blank, staff use only.

15. Estimated Funding. Check the appropriate box to indicate the grant year for which funding is 

being requested. Enter the amount requested or to be contributed during this budget period on 

each appropriate line, as shown below. The value of in-kind contributions should be included in 

these amounts, as applicable. For revisions (See item 8), if the action will result in a dollar change 

to an existing award, include only the amount of the change. For decreases, enclose the amounts 

in parentheses.

a. Federal The total amount of federal funds being requested in the budget.

b. Applicant The total amount of the applicant share as entered in the budget.

b. State The amount of the applicant share that is coming from state sources.

d. Local The amount of the applicant share that is coming from local governmental sources 

(e.g., city, county and other municipal sources).
26

e. Other The amount of the applicant share that is coming from non-governmental sources.

f. Program 

Income

The amount of the applicant share that is coming from income generated by 

programmatic activities (i.e., use of the additive option where program income is 

used to increase the size of the program).

g. Total The applicant's estimate of the total funding amount for the agreement.

16. Pre-filled for your convenience. This program is excluded from coverage by State Executive 

Order 12372. 

 17. Check the appropriate box. This question applies to the applicant organization, not the person 

who signs as the authorized representative. Categories of debt include delinquent audit 

allowances, loans, and taxes. If Yes, attach an explanation.

 18. The person who signs this form must be the applicant’s authorized representative. A copy of the 

governing body’s authorization for this official representative to sign must be on file in the 

applicant’s office. 

Note: Falsification or concealment of a material fact, or submission of false, fictitious or 

fraudulent statements or representations to any department or agency of the United States 

Government may result in a fine of not more than $10,000 or imprisonment for not more 

than five (5) years, or both. (18 U.S. Code Section 1001
27

APPLICATION FOR FEDERAL ASSISTANCE

Standard Form 424 (Rev. 2-2007) Prescribed by OMB Circular A-102

1. TYPE OF SUBMISSION:

Application Non-Construction

2. a. DATE SUBMITTED: 3. a. DATE RECEIVED BY STATE: 3. b. STATE APPLICATION IDENTIFIER:

2. b. APPLICATION IDENTIFIER: 

4. a. DATE RECEIVED BY FEDERAL 

AGENCY:

4. b. FEDERAL IDENTIFIER: (Staff Only)

5. APPLICANT INFORMATION

5. a. LEGAL NAME: 

5. b. ORGANIZATIONAL DUNS: 

5. c. ORGANIZATIONAL UNIT (DEPARTMENT/DIVISION): 

5. e. NAME AND TELEPHONE NUMBER OF PERSON TO BE CONTACTED ON

MATTERS INVOLVING THIS APPLICATION (give area code):

5. d. ADDRESS (give street address, city, county, state and zip code):

STREET:

CITY: COUNTY: 

STATE: COUNTRY: 

NAME: 

TELEPHONE NUMBER: ( ) -

FAX NUMBER: ( ) - EMAIL: 

INTERNET E-MAIL ADDRESS: 

WEBSITE: 

6. EMPLOYER IDENTIFICATION NUMBER (EIN): 7. a. TYPE OF APPLICANT: (enter appropriate letter in box)

A. State H. Independent School District

B. County I. State Controlled Institution of Higher Learning

C. Municipal J. Private University 

D. Township K. Indian Tribe

E. Interstate L. Individual

F. Intermunicipal M. Profit Organization

G. Special District N. Private Non-Profit Organization

 O. Federal Government P. HQ Internal Organizations

 Q. State Education Agency R. Territory 

S. Other (specify)

7. b. CNCS APPLICANT CHARACTERISTICS Enter appropriate codes: 

8. TYPE OF APPLICATION 

NEW NEW/PREVIOUS GRANTEE

CONTINUATION REVISION 

If Revision, enter appropriate letter(s) in box(es): 

A. AUGMENTATION B. BUDGET REVISION: 

C. NO COST EXTENSION to (enter date)

E. OTHER (specify below)

 

 

9. NAME OF FEDERAL AGENCY:

Corporation for National and Community Service

10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER:

 

11. a. DESCRIPTIVE TITLE OF APPLICANT’S PROJECT:

12. AREAS AFFECTED BY PROJECT (List Cities, Counties, States, etc.): 11.b. CNCS PROGRAM INITIATIVE (IF ANY): 

13. PROPOSED PROJECT: START DATE: ENDING DATE: 14. Performance Period (Staff Use Only_ 

15. ESTIMATED FUNDING: Check applicable box: Yr 1: Yr.2: Yr. 3: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE

ORDER 12372 PROCESS?

 a. YES. THIS PREAPPLICATION/APPLICATION WAS MADE 

AVAILABLE

 TO THE STATE EXECUTIVE ORDER 12372 PROCESSS FOR

 REVIEW ON:

 DATE ___________________________________

 b. NO. PROGRAM IS NOT COVERED BY E.O. 12372

 

 

17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?

 YES If ―Yes,‖ attach an explanation. NO

a. FEDERAL

$

b. APPLICANT

$

c. STATE

$

d. LOCAL

$

e. OTHER

$

f. PROGRAM 

INCOME $

g. TOTAL

$ 
28

18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT, THE DOCUMENT HAS BEEN 

DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE 

ASSISTANCE IS AWARDED.

a. TYPED NAME OF AUTHORIZED REPRESENTATIVE: b. TITLE: c. TELEPHONE NUMBER:

d. SIGNATURE OF AUTHORIZED REPRESENTATIVE: 

e. DATE SIGNED:

 
29

ATTACHMENT B: Focus Areas and Service Categories 

(eGrants Performance Measures Section)

Bolded Service Categories align with National Performance Measures

EDUCATION FOCUS AREA

College Access and Success

Cultural Heritage

Family Involvement

Job Preparedness/School to Work/Vocational Education/Youth ESL and GED

Leadership Development

Mentoring for Educational Success

Out of School Time/and or Summer Learning

Student Engagement2

School Climate3

School Readiness/Head Start/Early Childhood Education

Service-Learning

Teacher Recruitment, Classroom Education, Teacher Training, Teacher Aides, Retention

Tutoring 

ENVIRONMENTAL STEWARDSHIP FOCUS AREA

Air Quality Improvement

At-risk Ecosystems Improvement

Community Restoration/Clean Up

Energy Use Reduction

Environmental Awareness-building and Education

Indoor Environment Improvement

Park Facilities/Trail Improvement

Renewable Energy

Toxic Waste Management

Waste Reduction, Management, and Recycling

Drinking Water Quality and Availability Improvement

HEALTHY FUTURES FOCUS AREA

Adult Day Care

Benefits Assistance

Community Gardens

Congregate Meals

Health and Mental Health Crisis Intervention

 

Student engagement is frequently used to, "depict students' willingness to participate in routine school activities, 

such as attending class, submitting required work, and following teachers' directions in class.‖ Chapman, E. 

(2003) "Assessing student engagement rates," ERIC Clearinghouse on Assessment and Evaluation. ERIC 

identifier: ED482269. However, the term is also increasingly used to describe meaningful student involvement 

throughout the learning environment, including students participating curriculum design, classroom management 

and school building climate.

School climate refers to the quality and character of school life. School climate is based on patterns of students', 

parents' and school personnel's experience of school life and reflects norms, goals, values, interpersonal 

relationships, teaching and learning practices, and organizational structures. A sustainable, positive school climate 

fosters youth development and learning necessary for a productive, contributing and satisfying life in a democratic 

society.
30

Food Security

Health Education

Health Screening

HIV/AIDS

Hospice/Terminally Ill

Hospital and Clinical Support Services including Rehabilitation

Immunization

Independent Living

In-Home Care

Mental Health

Obesity Prevention and Nutrition Education

Parent Support

Physical and Developmental Disabilities 

Respite for Caregivers

Safety and Accident Prevention Services

Substance Abuse

Teen Pregnancy Prevention

Transportation for Independent Living

Violence, Abuse and Neglect Prevention and Services

DISASTER SERVICES FOCUS AREA

Disaster Mitigation including Fire Prevention and Firefighting

Disaster Preparedness

Disaster Recovery

Disaster Response

VETERANS AND MILITARY FAMILIES FOCUS AREA: 

Applicants that select this Focus Area will be able to choose from the complete list of service categories.

ECONOMIC OPPORTUNITY FOCUS AREA

Adult Education and Literacy (including ESL and GED)

Community Revitalization/Improvement

Computer Literacy

Consumer Education

Cooperatives/Credit Unions

Employment Services

Employment Training

Financial Asset Development

Financial Literacy

Foreclosure Prevention

Homeless Services

Housing Infrastructure

Housing Placement Services

Microenterprise Development and Support

Regional/State/City Planning

Tax Counseling

Workforce Development

CAPACITY BUILDING 

Non-profit Infrastructure Development including Organizational Development Assistance

Non-profit Resource Development (Cash or In-kind)

Volunteer Recruitment

Volunteer Management

OTHER

Community Policing/Community Patrol 
31

Conflict Resolution/Mediation

Household Safety and Security

Justice System

Legal Services 

Library Support Services

Mentoring for Purposes Other than Educational Success

Thrift Store/Reuse Retail

None of the Above/Other _________________________
32

ATTACHMENT C: Performance Measures Instructions 

(eGrants Performance Measures Section) 

AmeriCorps Performance Measures

To begin entering performance measures, from your eGrants grant application page select 

Performance Measures.

All applicants must complete Steps 1-6. Then, if you are:

Entering applicant-determined performance measures, follow steps 7A-18A.

Opting in to the National Performance Measures, follow steps 7B-17B.

Step 1: Select Characteristics. 

To begin, click one or more boxes in the ―Grant Characteristics‖

Step 2: Select Focus Areas

Select the Focus Area in which your primary service activity fits. You may also select ―Capacity 

Building‖ if this is a significant area of member activity. If your primary service activity does 

not fit into a Focus Area, select ―Other‖ and skip to Step 5. You may select multiple Focus Areas 

to represent significant areas of AmeriCorps member activity. Do not include multiple Focus 

Areas to describe the same activity. Select the Focus Area that best describes the activity.

Step 3: Choose whether to Opt-in to National Performance Measures:

When you select a Focus Area, eGrants automatically pre-populates the selection ―No‖ in 

response to the question ―Will you be using a national performance measure related to this Focus 

Area?‖

Leave this selection as ―No‖ if you do not want to participate in the National Performance 

Measures for that Focus Area.

Change the selection to ―Yes‖ if you want to opt-in to the National Performance Measures 

for that Focus Area.

You must consult the ―National Performance Measures Instructions‖ to determine which 

performance measures are appropriate for your program: 

http://www.americorps.gov/for_organizations/funding/nofa_detail.asp?tbl_nofa_id=91. You 

may also find resources at this link to be helpful: 

http://www.nationalserviceresources.org/national-performance-measures/home

If you selected ―Other‖ as your only Focus Area, you will skip this step as there are no National

Performance Measures for ―Other‖. 

Step 4: Complete the MSY Chart(s)

For each Focus Area selected, complete a Member Service Years (MSY) Chart. If you have 

selected Capacity Building or Other, complete an MSY Chart for these selections as well. Click 

the ―view/edit MSY Slots‖ orange link. There are two sets of numbers to enter in each MSY 
33

Chart. First, for each slot type, enter the number of members that will be providing service in that 

Focus Area.

Second, enter the percent of time that members of each slot type will spend on activities in that 

Focus Area. Use whole numbers to represent the percent. Do not use a % or a decimal. (For 

example, for 100 percent, type ―100.‖) eGrants will calculate the total MSYs for each slot type, 

then aggregate the MSYs for the entire chart in the ―Total MSYs Devoted to Priority‖ field at the 

bottom of the chart.

Note that MSYs in each category should be mutually exclusive. Do not double count MSYs. The 

total MSYs across all Focus Areas, Capacity Building, and Other should not exceed the total 

MSYs requested in the budget.

Step 5: Add a Service Category

For each Focus Area selected above, as well as Capacity Building and Other, you must select a 

Primary Service Category. Click the ―Add a Service Category‖ orange link. Select your Focus 

Area from the drop-down menu and click ―Go.‖ (See Attachement B for a list of service 

categories)

Select your Service Category from the options provided in the pop-up menu. The Service 

Category you select will determine the Indicator drop-down options in later steps.

If this is the first or only Service Category you select, eGrants will automatically check 

―Primary‖ to indicate this is your primary activity. To select more than one Service Category, 

simply click the ―add a service category‖ link. Only one Service Category should be indicated as 

the primary per Focus Area. You may add additional service categories if appropriate for your 

program design. Additional service categories may be labled as ―Secondary.‖

Step 6: Add a Performance Measure

You must create at least one aligned set of Performance Measures representing your Primary 

Service Activity, which is achieved through either National Performance Measures or applicantdetermined performance measures. An aligned measure includes and output and an outcome.

If you have opted-in to National Performance Measures, you will see the links for both 

―add a national performance measure‖ and ―add an applicant performance measure.‖ If you have 

not opted-in to National Performance Measures, you will only see the link for ―add an applicant

performance measure.‖

Choose National Performance Measures or Applicant-Performance Measures or 

Follow the instructions 7A – 17A for each aligned set of applicant-determined measures you 

need to create.

Follow the instructions for 7B – 17B for each aligned set of national performance measures

you need to create.
34

Applicant Performance Measures

Step 7A: Add a Performance Measure

Follow the instructions for 7A – 18A for each applicant-determined performance measure you 

will create. Begin by creating the Performance Measure Output and then repeat steps 13A-18A 

to create an aligned Intermediate Outcome.

Step 8A: Select a Focus Area

The Focus Area drop-down box will consist of all the focus areas that were initially select in the 

main Focus Area section.

Step 9A Add Performance Measure Title

Give this performance measure a title—usually 3-4 words that describe the activity— and enter it 

in the text box.

Step 10A: Select a Service Category

Service Category is a drop-down menu of choices based on your earlier identification of Service

Categories; select one and continue by pressing the ―go‖ button

Step 11A: Describe Strategies to Achieve Result

Briefly describe the intervention that will lead to the outcome you are proposing. Keep 

statements to one or two paragraphs with a maximum of 500 characters.

Step 12A: Select a Result Type

You will need to select the Result Type that you intend to track for this activity – output or 

intermediate outcome – and click ―Add New Results Section.‖ You should begin each aligned

measure with the selection of an Output Measure.

Step 13A: Write a Result Statement

Enter 1-2 sentences stating the expected output or outcome.

Step 14A: Select an Indicator

Select an Indicator from the drop- down menu. If the options provided do not include the

Indicator you are measuring, select ―other‖ and describe the Indicator in the text box that will 

appear. 

Step 15A: Write a Target Description

In 250 characters or less, include a description of the target. Be sure to include how you

determine what is counted in this target. For example: 100 parents will attend the eight-week 

parenting skills/drop-out prevention class.

Step 16A: Select a Target Number or Percent

Write the number from your target statement in the Target box and indicate whether it is a whole

number or percent
35

Step 17A: Identify your Instruments

Describe the Instruments that will be used to measure your output/outcome in 250 characters or 

less. These are specific tools to collect information such as a behavior checklist, tally sheet, 

attitude questionnaire, or interview protocol. 

Step 18A: Write a Performance Measure Statement

Provide the expected result and target combined into one or two sentences in 1,000 characters or 

less.

Once you have completed the output performance measurement information, do the same for 

your intermediate outcome and/or additional measures, if necessary. Begin by identifying the 

Result Type as ―intermediate outcome‖ and complete Steps 13A through 18A again. If you 

would like to enter an ―end outcome‖, you may do so by completing Steps 13A through 18A 

again. End outcomes are not required.

National Performance Measures

Follow the instructions for 7B –17B for each aligned set of National Performance Measures you 

need to create. You will use these instructions to complete measures if you have opted in to 

National Performance Measures for any Focus Area. Please refer to National Performance 

Measures Instructions for complete instructions for aligning measures.

If you select the Education Focus Area and opt-in to National Performance Measures, you 

are only allowed to select National Performance Measures. You are not allowed to add any 

additional, applicant-determined measures.

If you select the Disaster Services, Economic Opportunity, Environmental Stewardship,

Healthy Futures, or Veterans Focus Areas, or Capacity Building, and opt-in to National 

Performance Measures, you will enter your National Performance Measures. If you choose, 

you may add additional, applicant-determined Measures after you enter the National 

Performance Measures.

Step 7B: Add a National Performance Measure

Click the ―add a national performance measures‖ orange link. Then select the Focus Area. Only 

those Focus Areas that were checked as participating in the National Performance Measures will 

be displayed.

Step 8B: Add a Performance Measurement Title

Give this performance measure a title — usually 3-4 words that describe the activity — and enter 

it in the text box. Continue by pressing the ―go‖ button.

Step 9B: Describe Strategies to Achieve Result

Briefly describe the intervention that will lead to the outcome you are proposing. Keep 

statements to one or two paragraphs with a maximum of 500 characters.
36

Step 10B: Select a Result Type

You will need to select the Result Type that you intend to track for this activity – output or

intermediate outcome– and click ―Add New Results Section.‖ You should begin each aligned 

measure with the selection of an Output Measure.

Step 11B: Select the Indicator

This is where you select your National Performance Measure. There is a drop-down list 

containing the National Performance Measures for the Focus Areas that you have selected. 

Once you select your first National Performance Measure, eGrants will provide onscreen 

instructions about other National Performance Measures you must use in conjunction with this 

measure or if you need to add an applicant-determined intermediate outcome.

If you need to add an applicant-determined intermediate outcome measure, you will select

―Other‖ from the pop-up list.

Step 12B: Write Result Statement

Enter 1-2 sentences stating the expected output or outcome.

Step 13B Write a Target Description

In 250 characters or less, include a description of the target. Be sure to include how you 

determine what is counted in this target. For example: 100 parents will attend the eight-week 

parenting skills/drop-out prevention class.

Step 14B: Select a Target Number

Write the number in the Target box from your target description. You are only allowed to use a

number.

Step 15B: Identify your Instruments

Describe the Instruments that will be used to measure your output/outcome in 250 characters or 

less. These are specific tools to collect information such as a behavior checklist, tally sheet, 

attitude questionnaire, or interview protocol. Check for guidance on appropriate instruments 

posted at the National Performance Measures resource

page: http://nationalserviceresources.org/national-performance-measures/home

Step 16B: Write a Performance Measures Statement

Provide the expected result and target combined into one or two sentences (1,000 characters or 

less).

Step 17B: Create Aligned Measure

After completing the output performance measurement information, do the same for your 

intermediate outcome. Begin by identifying the Result Type, and then complete Steps 11B to 

16B again.

Once you complete entering an aligned measure as defined by the National Performance 

Measure, you will return to Step 7 and create any other aligned measures to report member 

activities in Focus Areas or other areas of service either by:
37

Following Steps 7A – 18A for an applicant-determined measure or

Following Steps 7B – 17B for an aligned National Performance Measure.
38

ATTACHMENT D: Detailed Budget Instructions (eGrants Budget 

Section)

Section I. Program Operating Costs

Complete Section I, Program Operating Costs, of the Budget Worksheet by entering the ―Total 

Amount,‖ ―CNCS Share,‖ and ―Grantee Share‖ for Parts A-I, for Year 1 of the grant, as follows:

A. Personnel Expenses 

Under ―Position/Title Description,‖ list each staff position separately and provide salary and 

percentage of effort as percentage of FTE devoted to this award. Each staff person’s role listed in 

the budget must be described in the application narrative and each staff person mentioned in the 

narrative must be listed in the budget as either CNCS or Grantee share. Because the purpose of 

this grant is to enable and stimulate volunteer community service, do not include the value of 

direct community service performed by volunteers. However, you may include the value of 

volunteer services contributed to the organization for organizational functions such as 

accounting, audit work, or training of staff and AmeriCorps members.

B. Personnel Fringe Benefits

Under ―Purpose/Description,‖ identify the types of fringe benefits to be covered and the costs of 

benefit(s) for each staff position. Allowable fringe benefits typically include FICA, Worker’s 

Compensation, Retirement, SUTA, Health and Life Insurance, IRA, and 401K. You may provide 

a calculation for total benefits as a percentage of the salaries to which they apply or list each 

benefit as a separate item. If a fringe benefit amount is over 30%, please list covered items 

separately and justify the high cost. Holidays, leave, and other similar vacation benefits are not 

included in the fringe benefit rates, but are absorbed into the personnel expenses (salary) budget 

line item. 

C. 1. Staff Travel

Describe the purpose for which program staff will travel. Provide a calculation that includes 

itemized costs for airfare, transportation, lodging, per diem, and other travel-related expenses 

multiplied by the number of trips/staff. Where applicable, identify the current standard 

reimbursement rate(s) of the organization for mileage, daily per diem, and similar supporting 

information. The standard mileage reimbursement should not exceed the federal mileage rate 

unless a result of applicant policy and justified in the budget narrative. Only domestic travel is 

allowable.

We expect all applicants to include funds in this line item for travel for staff and site staff to 

attend CNCS-sponsored technical assistance meetings. There are two to three such 

opportunities per year, including the Financial Management Institute and the Annual 

Grantee Meeting in Washington DC in the fall.

Please itemize the costs. For example: Two staff members will attend the Annual Grantee 

Meeting in Washington, DC. 

2 staff X $750 airfare + $50 ground transportation + (1 day) X $400 lodging + $35 per diem = 

$2,470 for Annual Grantee Meeting.
39

C. 2. Member Travel

Describe the purpose for which members will travel. Provide a calculation that includes itemized 

costs for airfare, transportation, lodging, per diem, and other related expenses for members to 

travel outside their service location or between sites. Costs associated with local travel, such as 

bus passes to local sites, mileage reimbursement for use of car, etc., should be included in this 

budget category. Where applicable, identify the current standard reimbursement rate(s) of the 

organization for mileage, daily per diem, and similar supporting information. 

D. Equipment

Equipment is defined as tangible, non-expendable personal property having a useful life of more 

than one year AND an acquisition cost of $5,000 or more per unit (including accessories, 

attachments, and modifications). Any items that do not meet this definition should be entered in 

E. Supplies below. Purchases of equipment are limited to 10% of the total CNCS funds 

requested. If applicable, show the unit cost and number of units you are requesting. Provide a 

brief justification for the purchase of the equipment under Item/Purpose.

E. Supplies

Include the amount of funds to purchase consumable supplies and materials, including member 

service gear and equipment that does not fit the definition above. You must individually list any 

single item costing $1,000 or more. Except for safety equipment, grantees may only charge the 

cost of member service gear to the federal share if it includes the AmeriCorps logo. Grantees 

may also add the AmeriCorps logo to their own local program uniform items using federal funds. 

All safety gear may be charged to the federal share, regardless of whether it includes the 

AmeriCorps logo. All other service gear must be purchased with non-CNCS funds.

F. Contractual and Consultant Services

Include costs for consultants related to the project’s operations, except training or evaluation 

consultants, who will be listed in Sections G. and H., below. Payments to individuals for 

consultant services under this grant should not exceed $750 per day (excluding costs for travel, 

supplies, etc.). The $750 daily rate is a ceiling, and we anticipate budgeted daily rates at 

considerably lower levels. Indicate the daily rate, number of days, and total cost for consultants 

you are proposing to use and their contractual services. Daily rates over the maximum amount 

should be justified in the narrative.

G. 1. Staff Training

Include the costs associated with training staff on project requirements and training to enhance 

the skills staff need for effective project implementation, i.e., project or financial management, 

team building, etc. If using a consultant(s) for training, indicate the estimated daily rate, not to 

exceed the maximum daily rate limit of $750. 

G. 2. Member Training

Include the costs associated with member training to support them in carrying out their service 

activities. You may also use this section to request funds to support training in Life after 

AmeriCorps. If using a consultant(s) for training, indicate the estimated daily rate, not to exceed 

the daily rate limit. 
40

H. Evaluation

Include costs for project evaluation activities, including additional staff time or subcontracts, use 

of evaluation consultants, purchase of instrumentation, and other costs specifically for this 

activity not budgeted in Personnel Expenses. This cost does not include the daily/weekly 

gathering of data to assess progress toward meeting performance measures, but is a larger 

assessment of the impact your project is having on the community, as well as an assessment of 

the overall systems and project design. Indicate daily rates of consultants, where applicable.

I. Other Program Operating Costs

Allowable costs in this budget category should include when applicable:

Criminal history background checks for all members and for all employees or other 

individuals who receive a salary, education award, living allowance, or stipend or similar 

payment from the grant (federal or non-federal share).

Office space rental for projects operating without an approved indirect cost rate agreement 

that covers office space. If space is budgeted and it is shared with other projects or activities, 

the costs must be equitably pro-rated and allocated between the activities or projects.

Utilities, telephone, internet and similar expenses that are specifically used for AmeriCorps 

members and AmeriCorps project staff, and are not part of the organization’s indirect cost

allocation pool. If such expenses are budgeted and shared with other projects or activities, the 

costs must be equitably pro-rated and allocated between the activities or projects.

Recognition costs for members. List each item and provide a justification in the budget 

narrative. Gifts and/or food in an entertainment/event setting are not allowable costs. 

Multi-state applicants: Indicate the number of subgrants and the average amount of 

subgrants. Indicate any match that you will require of your subgrants under the ―grantee 

share‖ column in this category. Subgranted funds may only cover costs allowable under 

federal and AmeriCorps regulations and provisions.

Section II. Member Costs

Member Costs are identified as ―Living Allowance‖ and ―Member Support Costs.‖ Your

required match can be federal, state, local, or private sector funds.

A. Living Allowance

The narrative should clearly identify the number of members you are supporting by category 

(i.e., full-time, half-time, reduced-half-time, quarter-time, minimum-time) and the amount of 

living allowance they will receive, allocating appropriate portions between the CNCS share 

(CNCS Share) and grantee match (Grantee Share). 

The minimum and maximum living allowance amounts are provided below. 

Minimum and Maximum Living Allowance

Service Term Minimum # of 

Hours

Minimum Living 

Allowance

Maximum Total 

Living Allowance 
41

In eGrants, enter the total number of members you are requesting in each category. Enter the 

average amount of the living allowance for each type of member. In addition, enter the number 

of members for which you are not requesting funds for a living allowance, but for which you are 

requesting education awards. 

B. Member Support Costs

Consistent with the laws of the states where your members serve, you must provide members 

with the benefits described below. 

FICA. Unless exempted by the IRS, all projects must pay FICA for any member receiving a 

living allowance, even when CNCS does not supply the living allowance. If exempted, please 

note in the narrative. In the first column next to FICA, indicate the number of members who 

will receive FICA. Calculate the FICA at 7.65% of the total amount of the living allowance. 

Worker’s Compensation. Some states require worker’s compensation for AmeriCorps 

members. You must check with State Departments of Labor or State Commissions where 

members serve to determine if you are required to pay worker’s compensation and at what 

level. If you are not required to pay worker’s compensation, you must obtain Occupational, 

Accidental, Death and Dismemberment coverage for members to cover in-service injury or 

accidents.

Health Care. You must offer or make available health care benefits to full-time members in 

accordance with AmeriCorps requirements. Except as stated below, you may not pay health 

care benefits to less-than-full-time members with CNCS funds. You may choose to provide 

health care benefits to less-than-full-time members from other sources (i.e., non-federal) but 

the cost cannot be included in the budget. Less-than-full-time members who are serving in a 

full-time capacity for a sustained period of time (such as a full-time summer project) are 

eligible for health care benefits. In your budget narrative, indicate the number of members 

who will receive health care benefits. CNCS will not pay for dependent coverage. 

Unemployment Insurance and Other Member Support Costs. Include any other required 

member support costs here. Some states require unemployment coverage for their 

AmeriCorps members. You may not charge the cost of unemployment insurance taxes to the 

grant unless mandated by state law. Programs are responsible for determining the 

requirements of state law by consulting State Commissions, legal counsel, or the applicable 

state agencies.

Section III. Administrative/Indirect Costs 

Full-time 1700 $12,100 $24,200

One-year Half-time 900 n/a $12,800

Two-year Half-time 900 n/a $12,800

Reduced Half-time 675 n/a $9,600

Quarter-time 450 n/a $6,400

Minimum-time 300 n/a $4,300
42

Definitions 

Administrative costs are general or centralized expenses of the overall administration of an 

organization that receives CNCS funds and do not include particular project costs. These costs 

may include administrative staff positions. For organizations that have an established indirect 

cost rate for federal awards, administrative costs mean those costs that are included in the 

organization’s indirect cost rate agreement. Such costs are generally identified with the 

organization’s overall operation and are further described in Office of Management and Budget 

Circulars A-21, A-87, and A-122. 

Options for Calculating Administrative/Indirect Costs (choose either A OR B)

Applicants choose one of two methods to calculate allowable administrative costs – a CNCSfixed percentage rate method or a federally approved indirect cost rate method. Regardless of the 

option chosen, the CNCS share of administrative costs is limited to 5% of the total CNCS funds 

actually expended under this grant. 

A. CNCS-Fixed Percentage Method

Five Percent Fixed Administrative Costs Option

The CNCS-fixed percentage rate method allows you to charge administrative costs up to a cap 

without a federally approved indirect cost rate and without documentation supporting the 

allocation. If you choose the CNCS-fixed percentage rate method (Section IIIA in eGrants), you 

may charge, for administrative costs, a fixed 5% of the total of the CNCS funds expended. In 

order to charge this fixed 5%, the grantee match for administrative costs may not exceed 10% of 

all direct cost expenditures. 

1. To determine the maximum CNCS share for Section III: Multiply the sum of the CNCS

funding shares of Sections I and II by 0.0526. This is the maximum amount you can request as 

Corporation share. The factor 0.0526 is used to calculate the 5% maximum amount of federal 

funds that may be budgeted for administrative (indirect) costs, rather than 0.0500, as a way to 

mathematically compensate for determining Section III costs when the total budget (Sections I + 

II + III) is not yet established. Enter this amount as the CNCS share for Section III A. 

2. To determine the Grantee share for Section III: Multiply the total (both Corporation and 

grantee share) of Sections I and II by 10% (0.10) and enter this amount as the grantee share 

for Section III A.

3. Enter the sum of the CNCS and grantee shares under Total Amount. 

If a commission elects to retain a share of the 5% of federal funds available to programs for 

administrative costs, that decision is identified within each subgrant’s budget. To calculate these 

fractional shares, within Section III of the subgrant budget, one-fifth (20%) of the federal 

dollars budgeted for administrative costs is allocated to the commission’s share and fourfifths (80%) of the federal dollars budgeted for administrative costs are allocated to the 

program’s share. The allocation between commission and program shares would be 

calculated as follows:

([Section I] + [Section II] x 0.0526) x (0.20) = Commission Share
43

([Section I] + [Section II] x 0.0526) x (0.80) = Subgrantee Share

If a commission elects to retain a share that is less than 1% budgeted for administrative costs, 

adjust the calculation above, as appropriate.

B. Federally Approved Indirect Cost Rate 

If you have a federally approved indirect cost rate and choose to use it, the rate will constitute 

documentation of your administrative costs, including the 5% maximum payable by CNCS. 

Specify the Cost Type for which your organization has current documentation on file, i.e., 

Provisional, Predetermined, Fixed, or Final indirect cost rate. Supply your approved IDC rate 

(percentage) and the base upon which this rate is calculated (direct salaries, salaries and fringe 

benefits, etc.). It is at your discretion whether or not to claim your entire IDC rate to calculate 

administrative costs. If you choose to claim a lower rate, please include this rate in the Rate 

Claimed field. 

1. Determine the base amount of direct costs to which you will apply the IDC rate, including 

both the CNCS and Grantee shares, as prescribed by your established rate agreement (i.e., based 

on salaries and benefits, total direct costs, or other). Then multiply the appropriate direct costs by 

the rate being claimed. This will determine the total amount of indirect costs allowable under the 

grant. 

2. To determine the CNCS share: Multiply the sum of the CNCS funding share in Sections I and 

II by 0.0526. This is the maximum amount you can claim as the CNCS share of indirect costs.

3. To determine the Grantee share: Subtract the amount calculated in step b (the CNCS

administrative share) from the amount calculated in step a (the Indirect Cost total). This is the 

amount the applicant can claim as grantee share for administrative costs.

Source of Match

In the ―Source of Match‖ field that appears at the end of Budget Section III, enter a brief 

description of the Source of Match, the amount, the match classification (Cash, In-kind, or Not 

Available) and Match Source (State/Local, Federal, Private, Other or Not Available) for your 

entire match. Define any acronyms the first time they are used.
44

ATTACHMENT E: Budget Worksheet (eGrants Budget Section)

Section I. Program Operating Costs

A. Personnel Expenses

Position/Title/Description Qty Annual Salary % Time Total Amount CNCS Share Grantee Share

Totals

B. Personnel Fringe Benefits

Purpose/Description Calculation Total Amount CNCS Share Grantee Share

Totals

C.1. Staff Travel

Purpose Calculation Total Amount CNCS Share Grantee Share

Totals

C. 2. Member Travel

Purpose Calculation Total Amount CNCS Share Grantee Share

Totals

D. Equipment

Item/ Purpose/Justification Qty Unit Cost Total Amount CNCS Share Grantee Share

Totals

E. Supplies

Purpose Calculation Total Amount CNCS Share Grantee Share

Totals
45

F. Contractual and Consultant Services

Purpose Calculation Daily 

Rate Total Amount CNCS Share Grantee Share

Totals

G.1. Staff Training

Purpose Calculation Daily 

Rate Total Amount CNCS Share Grantee Share

Totals

G.2. Member Training

Purpose Calculation Daily 

Rate Total Amount CNCS Share Grantee Share

Totals

H. Evaluation

Purpose Calculation Daily 

Rate Total Amount CNCS Share Grantee Share

Totals

I. Other Program Operating Costs

Purpose Calculation Daily 

Rate Total Amount CNCS Share Grantee Share

Totals

Subtotal Section I: Total Amount CNCS Share Grantee Share
46

Section II. Member Costs

A. Living Allowance

Item # 

Mbrs

Allowance 

Rate

# w/o 

Allowanc

e

Total Amount CNCS Share Grantee Share

Full Time (1700 hrs)

Half Time (900 hrs)

1st Year of 2-Year Half Time

2

nd Year of 2-Year Half Time

Reduced Half Time (675 hrs)

Quarter Time (450 hrs)

Minimum Time (300 hrs)

Totals

B. Member Support Costs

Purpose Calculation Daily 

Rate Total Amount CNCS Share Grantee Share

Totals

Subtotal Section II: Total Amount CNCS Share Grantee Share

Subtotal Sections I + II:
47

Section III. Administrative/Indirect Costs

A. CNCS-fixed Percentage Rate

Purpose Calculation Total Amount CNCS Share Grantee Share

Totals

B. Federally Approved Indirect Cost Rate 

Cost 

Type

Cost

Basis

Calculation Rate Rate 

Claimed

Total Amount CNCS Share Grantee Share

Total Sections I + II + III: Total Amount CNCS Share Grantee Share

Budget Total: Validate this budget

Required Match Percentages:

Total Amount CNCS Share Grantee Share

Source of Match

Source(s), Type, Amount, Intended Purpose

Private State and/or Local Federal Sources

In-kind $ $ $ .

Cash $ $ $

Total $ $ $
48

ATTACHMENT F: Detailed Budget Instructions for Fixed-amount 

Grants (eGrants Budget Section)

These instructions apply only to applicants for fixed-amount grants, including education 

award programs (EAPs).

EAP and Fixed-Amount Grant applicants may only request a fixed amount of funding per MSY. 

Therefore, Fixed-Amount applicants are not required to complete a detailed budget. In addition, 

the matching requirements in 45 CFR §§ 2521.40– 2521.95 do not apply to EAP and other 

Fixed-Amount grant applicants. Fixed-Amount applicants, except for EAP applicants, must 

include only full-time members.

Budget Section II. AmeriCorps Member Positions

A. Budget Section II: Full-Time Fixed-Amount Grants 

Enter the number of full-time positions you are requesting under the column labeled without 

(w/o) living allowance. You may not request less than full-time positions unless you are applying 

for an Education Award Program.

Under ―calculation‖ you will enter the calculation for your grant request. Leave all other 

columns blank.

Member Positions Cost per MSY Total Cost

_____Full-time (1700 hours) x $__________ = $ 

Enter the total amount requested in the ―Total Amount‖ & ―CNCS Share‖ columns. Leave the 

―Grantee Share‖ blank. 

Please note that the final amount that a program receives will be adjusted to reflect actual hours 

served if a member does not serve the minimum number of hours necessary to complete a full 

term of service.

B. Section II: EAPs

Member Positions

Identify the number of Education Award members you are requesting by category (i.e. full-time, 

half-time, reduced half-time, quarter-time, minimum-time) and list under the column labeled 

#w/o Allow (without CNCS-funded living allowance.) Leave all other columns blank.

The total number of member service years (MSY) will automatically calculate at the bottom of 

the Member Positions chart.The MSY are calculated as follows:

Calculation MSY
49

Member Positions

_____Full-time (1700 hours) (______ members x 1.000) = 

_____1-Year Half-time (900 hours) (______ members x 0.500) =

_____ 2-Year Half-time (1st Year)

(generally 450 hours) (______ members x 0.500) =

_____ 2-Year Half-time (2nd Year)*

(generally 450 hours) (______ members x 0.000)* =

_____Reduced half-time (675 hours) (______ members x 0.3809524) =

_____Quarter-time (450 hours) (______ members x 0.26455027) =

_____Minimum-time (300 hours) (______ members x 0.21164022) =

Total MSY 

* Grantees receive the total amount for 2-Year Half-time members in the first year. Therefore, 2-Year Half-time 

members serving in their second year are not included in the calculation for funds.

Under ―Calculation,‖ you will enter the calculation for your grant request. Applicants may 

request up to $800 per member service year (MSY).

Display your calculation in the following format:

Type the total amount requested in the ―Total Amount‖ & ―CNCS Share‖ columns. Leave the 

―Grantee Share‖ blank. See example below:

Purpose Calculation Total 

Amount

CNCS 

Share

Grantee 

Share

edit del

Program Grant 

Request

47.5 MSY 

X $800/MSY

$38,000 $38,000 $0

view

Subtotal $38,000 $38,000 $0

Total # of MSYs ________ x MSY amount (up to $800)_______ = Total Grant Request $____
50

ATTACHMENT G: Budget Worksheet for Fixed-Amount Grants 

(eGrants Budget Section)

If you are applying for a Full-Time Fixed-Amount grant, complete only the full-time fields in 

this table.Education Award Program applicants may complete other than full-time fields.

Member Positions

Item # 

Mbrs

Allowance 

Rate

# w/o 

Allow

Total 

Amount

CNCS 

Share

Grantee 

Share

Full Time (1700 hrs)

1-Year Half Time (900 

hrs)

2-Year Half Time (1st

Year)

2-Year Half Time (2nd

Year) 

Reduced Half Time

(675 hrs)

Quarter Time (450 hrs)

Minimum Time (300 hrs)

Subtotal MSY Cost/MSY

Purpose Calculation Total 

Amount

CNCS Share Grantee 

Share

Program Grant 

Request

Subtotal
51

ATTACHMENT H: Budget Checklist

Below is a checklist to help you make certain that you submit an accurate budget narrative that 

meets AmeriCorps requirements. 

In Compliance? Section I. Program Operating Costs

Yes __ No __

Costs charged under the Personnel line item directly relate to the operation of the AmeriCorps 

project? Examples include costs for staff that recruit, train, place, or supervise members as well as 

manage the project.

Yes __ No __

Staff indirectly involved in the management or operation of the applicant organization is funded 

through the administrative cost section (Section III.) of the budget? Examples of administrative 

costs include central management and support functions.

Yes __ No __

Staff fundraising expenses are not charged to the grant? You may not charge AmeriCorps staff 

members’ time and related expenses for fundraising to the federal or grantee share of the grant. 

Expenses incurred to raise funds must be paid out of the funds raised. Development officers and 

fundraising staff are not allowable expenses.

Yes __ No __ All positions in the budget are fully described in the narrative?

Yes __ No __

The types of fringe benefits to be covered and the costs of benefit(s) for each staff position are 

described? Allowable fringe benefits typically include FICA, Worker’s Compensation, Retirement, 

SUTA, Health and Life Insurance, IRA, and 401K. You may provide a calculation for total benefits 

as a percentage of the salaries to which they apply or list each benefit as a separate item. If the 

fringe amount is over 30%, please list separately. Holidays, leave, and other similar vacation 

benefits are not included in the fringe benefit rates but are absorbed into the personnel expenses 

(salary) budget line item?

Yes __ No __ Holidays, leave, and other similar vacation benefits are not included in the fringe benefit rates but 

are absorbed into the personnel expenses (salary) budget line item?

Yes __ No __ The purpose for all staff and member travel is clearly identified?

Yes __ No __ You have budgeted funds for staff travel to CNCS sponsored meetings in the budget narrative under 

Staff Travel?

Yes __ No __ Funds to pay relocation expenses of AmeriCorps members are not in the federal share of the 

budget?

Yes __ No __ Funds for the purchase of equipment (does not include general use office equipment) are limited to 

10% of the total grant amount?

Yes __ No __ All single equipment items over $5000 per unit are specifically listed?

Yes __ No __ Justification/explanation of equipment items is included in the budget narrative?

Yes __ No __ All single supply items over $1000 per unit are specifically listed?

Yes __ No __ You only charged to the federal share of the budget member service gear that includes the 

AmeriCorps logo, with the exception of safety equipment?

Yes __ No __ Are all consultant services budgeted below the maximum federal daily rate of $750/day? Is the daily 

rate noted in all sections of the budget narrative where consultants are proposed?

Yes __ No __ Does the budget reflect adequate budgeted costs for project evaluation?

Yes __ No __ Have you provided budgeted costs for background checks of members and grant-funded staff that 

are in covered positions per 45 CFR 2522.205?

Yes __ No __ Are all items in the budget narrative itemized and the purpose of the funds justified?
52

In Compliance? Section II. Member Costs

 Yes __ No __

Are the living allowance amounts correct? Full-time AmeriCorps members must receive at least the 

minimum living allowance.

Note: Programs in existence prior to September 21, 1993 may offer a lower living allowance than 

the minimum. If such a program chooses to offer a living allowance, it is exempt from the minimum 

requirement, but not from the maximum requirement. 

Yes __ No __

Living allowances are not paid on an hourly basis? They may be calculated using service hours and 

program length to derive a weekly or biweekly distribution amount. Divide the distribution in equal 

increments that are not based on the specified number of hours served.

Yes __ No __ Is FICA calculated correctly? You must pay FICA for any member receiving a living allowance. 

Unless exempted by the IRS, calculate FICA at 7.65% of the total amount of the living allowance. 

Yes __ No __

Is the Worker’s Compensation calculation correct? Some states require worker’s compensation for 

AmeriCorps members. Check with your local State Department of Labor or State Commission to 

determine whether or not you are required to pay worker’s compensation and at what level (i.e., 

rate). If you are not required to pay worker’s compensation, you need to provide similar coverage 

for members’ on-the-job injuries through their own existing coverage or a new policy purchased in 

accordance with normal procedures (i.e., Death and Dismemberment coverage).

Yes __ No __

Health care is provided for full-time AmeriCorps members only (unless part-time serving in a fulltime capacity)? If your project chooses to provide health care to other half-time members, you may 

not use federal funds to help pay for any portion of the cost. Projects must provide health care 

coverage to all full-time members who do not have adequate health care coverage at the time of 

enrollment or who lose coverage due to participation in the project. In addition, projects must 

provide coverage if a full-time member loses coverage during the term of service through no 

deliberate act of his/her own. 

In Compliance? Section III. Administrative/Indirect Costs

Yes __ No __

Applicant has chosen Option A – CNCS-fixed percentage method and the maximum federal share 

of administrative costs does not exceed 5% of the total federal funds budgeted? To determine the 

federal administrative share, multiply all other budgeted federal funds by .0526.

Yes __ No __ Applicant has chosen Option A – CNCS fixed percentage method and the maximum grantee share 

is at 10% or less of total budgeted funds? 

Yes __ No __

Applicant has chosen Option B – federally approved indirect cost rate method and documentation 

submitted to CNCS if multi-state, state or territory without commission or Indian Tribe applicant? 

Administrative costs budgeted include the following: (1) indirect costs such as legal staff, central 

management and support functions; (2) costs for financial, accounting, audit, internal evaluations, 

and contracting functions; (3) costs for insurance that protects the entity that operates the project; 

and (4) the portion of the salaries and benefits of the director and any other project administrative 

staff not attributable to the time spent in direct support of a specific project.

Yes __ No __ Applicant has chosen Option B – The maximum grantee share does not exceed the federally

approved rate, less the 5% CNCS share? 

In Compliance? Match

Yes __ No __ Is the overall match being met at the required level, based on the year of funding?

Yes __ No __

For all matching funds, the source(s) [private, state and local, and federal], the type of contribution 

(cash or in-kind), and the amount (or an estimate) of match, are clearly identified in the narrative 

and in the Source of Match field in eGrants? 
53

ATTACHMENT I: Alternative Match Instructions

Grantees are required to meet an overall matching rate that increases over time. You have the 

flexibility to meet the overall match requirements in any of the three budget areas, as long as the 

minimum match of 24% for the first three years, and the increasing minimums in years 

thereafter, are maintained. See 45 CFR §§ 2521.35–2521.90 for the specific regulations.

Special Circumstances for an Alternative Match Schedule: Under certain circumstances, 

applicants may qualify to meet alternative matching requirements that increase over the years to 

35% instead of 50% as specified in the regulations at §2521.60(b). To qualify, you must 

demonstrate that your program is either located in a rural county or in a severely economically 

distressed community as defined below.

A. Rural County: In determining whether a program is rural, CNCS will consider the most 

recent Beale code rating published by the U.S. Department of Agriculture for the county in 

which the program is located. Any program located in a county with a Beale code of 6, 7, 8 or 9 

is eligible to apply for the alternative match requirement. See Attachment K for the Table of 

Beale codes.

B. Severely Economically Distressed County: In determining whether a program is located in 

a severely economically distressed county, CNCS will consider the following list of countylevel characteristics. See Attachment K for a list of website addresses where this publicly 

available information can be found.

The county-level per capita income is less than or equal to 75 percent of the national 

average for all counties using the most recent census data or Bureau of Economic 

Analysis data;

The county-level poverty rate is equal to or greater than 125 percent of the national 

average for all counties using the most recent census data; and

The county-level unemployment is above the national average for all counties for the 

previous 12 months using the most recently available Bureau of Labor Statistics data. 

The areas served by the program lack basic infrastructure such as water or electricity. 

C. Program Location: Except when approved otherwise, CNCS will determine the location of 

your program based on the legal applicant’s address. If you believe that the legal applicant’s 

address is not the appropriate way to consider the location of your program, you must provide 

relevant facts about your program location in your request. CNCS will, in its sole discretion, 

determine whether some other address is more appropriate for determining a program’s location.

If your program is located in one of these areas, see the instructions below for applying for this 

alternative match schedule. You must submit your request to the alternative schedule at least 60 

days before the AmeriCorps application is due. CNCS will review your request and notify you 

within 30 days if you qualify for the alternative schedule and provide instructions for entering 

your budget into eGrants under the Alternative Match Schedule.

If approved for the alternative schedules, programs will base their budget in the upcoming 

application on the approved alternative match. The alternative match requirement will be in 
54

effect for whatever portion of the three-year project period remains or if applying as a new 

grantee, for the upcoming three-year grant cycle.

D. Instructions for the Alternative Match Schedule: Programs operating in one state must 

send their requests to the State Commission for review and approval. The Commission will then 

forward the approved request to CNCS for consideration. 

Submit e-mail applications at least 60 days prior to the application deadline to:

State Programs – submit to your State Commission

Multi-state Programs – submit to ACAlternateMatchScheduleRequests@cns.gov

State Commissions (on behalf of state programs) – submit to 

ACAlternateMatchScheduleRequests@cns.gov

E-mail subject line: AmeriCorps Alternative Match Request

Send your request in memo format. You must respond to each item below. Please include 

both the item and your response in your request. 

1. Basis of Request

a. Identify the basis for your request as either a rural county or a severely economically 

distressed community as described above. 

b. Describe where your program operates and include the address of the legal applicant.

2. Rural Counties

c. Describe the economic conditions. 

d. Confirm that your county has a Beale code of 6, 7, 8, or 9.

3. Economically Distressed Counties:

e. Provide your county per-capita income, poverty, and unemployment levels. 

f. Demonstrate that your county per-capita income, poverty, and unemployment levels 

are above or below the national averages. Identify the data source(s) used to make 

your determination. 

g. Provide any other statistics you deem relevant to demonstrate your county is 

economically distressed.

4. Program Location: If you believe the location of your program should not be based on the 

address of the legal applicant, describe your justification for requesting an alternative location(s).

5. Other: Provide any other justification and information for your request that is not presented 

in the responses to the above.
55

 

 

 

 

Applicant’s (Organization) Name: 

Applicant’s DUNS Number: 

Federal Program: CFDA Number: 

1. Has the applicant ever received a grant or 

contract from the Federal government?

Yes No

2. Is the applicant a faith-based organization? 

Yes No

3. Is the applicant secular organization? 

Yes No

4. Does the applicant have 501(c) (3) status?

Yes No

5. Is the applicant a local affiliate of a national 

organization? 

Yes No 

6. How many full-time equivalent employees does 

the applicant have? (Check only one box).

3 or Fewer 15-50 

4-5 51-100

6-14 over 100

7. What is the size of the applicant’s annual budget? 

(Check only one box.)

Less Than $150,000

$150,000 - $299,999

$300,000 - $499,999

$500,000 - $999,999

$1,000,000 - $4,999,999

$5,000,000 or more

Purpose: The Federal government is committed to ensuring that all qualified applicants, small or large, non-religious or faith-based, have an equal 

opportunity to compete for Federal funding. In order for us to better understand the population of applicants for Federal funds, we are asking nonprofit 

private organizations (not including private universities) to fill out this survey. 

Upon receipt, the survey will be separated from the application. Information provided on the survey will not be considered in any way in making 

funding decisions and will not be included in the Federal grants database. While your help in this data collection process is greatly appreciated, 

completion of this survey is voluntary. 

Instructions for Submitting the Survey: If you are applying using a hard copy application, please place the completed survey in an envelope labeled 

―Applicant Survey.‖ Seal the envelope and include it along with your application package. If you are applying electronically, please submit this 

survey along with your application. 

ATTACHMENT J: SURVEY ON ENSURING

EQUAL OPPORTUNITY FOR APPLICANTS

OMB NO. 1894-0010 EXP 5/31/2012

O
56

Survey Instructions on Ensuring Equal Opportunity for Applicant

Provide the applicant’s (organization) 

name and DUNS number and the grant 

name and CFDA number.

1. Self-explanatory.

2. Self-identify. 

3. Self-identify.

4. 501(c) (3) status is a legal designation 

provided on application to the Internal 

Revenue Service by eligible 

organizations. Some grant programs may 

require nonprofit applicants to have 

501(c)(3) status. Other grant programs do 

not. 

5. Self-explanatory.

6. For example, two part-time employees 

who each work half-time equal one fulltime equivalent employee. If the 

applicant is a local affiliate of a national 

organization, the responses to survey 

questions 2 and 3 should reflect the staff 

and budget size of the local affiliate. 

7. Annual budget means the amount of 

money your organization spends each 

year on all of its activities.

Paperwork Burden Statement

According to the Paperwork 

Reduction Act of 1995, no persons are 

required to respond to a collection of 

information unless such collection 

displays a valid OMB control number. 

The valid OMB control number for 

this information collection is 1894-

0010. The time required to complete 

this information collection is 

estimated to average five (5) minutes 

per response, including the time to 

review instructions, search existing 

data resources, gather the data needed, 

and complete and review the 

information collection. If you have 

any comments concerning the 

accuracy of the time estimate(s) or 

suggestions for improving this 

form, please write to: Amy 

Borgstrom, Corporation for National 

and Community Service, 1201 New 

York Avenue, NW, Washington, D.C. 

20525.
57

ATTACHMENT K: Beale Codes and County-Level Economic Data

Rural Community

Beale codes are published by the U.S. Department of Agriculture and are used to classify 

counties as being more urban or more rural. Counties are designated on a scale from one to nine 

according to the following descriptions:

2003 Beale Codes

Code# Metropolitan 

Type

Description

1 Metropolitan Counties in metro areas of 1 million population or more

2 Metropolitan Counties in metro areas of 250,000 to 1 million

3 Metropolitan Counties in metro areas of fewer than 250,000

4 Non-metro

Urban population of 20,000 or more, adjacent to a metropolitan 

area 

5 Non-metro Urban population of 20,000 or more, not adjacent to a 

metropolitan area

6 Non-metro Urban population of 2,500 to 19,999, adjacent to a metropolitan 

area

7 Non-metro Urban population of 2,500 to 19,999, not adjacent to a 

metropolitan area 

8 Non-metro

Completely rural or less than 2,500 urban population, adjacent to 

a metropolitan area

9 Non-metro

Completely rural or less than 2,500 urban population, not 

adjacent to a metropolitan area

Any program located in a county with a Beale code of 6, 7, 8, or 9 is eligible to apply for the 

alternative match.
58

Severely Economically Distressed Community

The following table provides the website addresses where the publicly available information on 

county-level economic data including per capita income, poverty rate, and unemployment levels 

can be found.

WEBSITE ADDRESS EXPLANATION

www.econdata.net Econdata.Net: This site Links to a variety 

of social and economic data by states, 

counties and metro areas.

http://www.bea.gov/regional/ Bureau of Economic Analysis’ Regional 

Economic Information System (REIS):

Provides data on per capita income by 

county for all states except Puerto Rico.

www.census.gov/hhes/www/saipe/index.html Census Bureau’s Small Area Poverty 

Estimates: Provides data on poverty and 

population estimates by county for all 

states except Puerto Rico.

www.census.gov/main/www/cen2000.html Census Bureau’s American Fact-finder: 

Provides all 1990 and 2000 census data 

including estimates on poverty, per capita 

income and unemployment by counties, 

states, and metro areas including Puerto 

Rico.

www.bls.gov/lau/home.htm Bureau of Labor Statistics’ Local Area 

Unemployment Statistics (LAUS): 

Provides data on annual and monthly 

employment and unemployment by 

counties for all states including Puerto 

Rico.

http://www.ers.usda.gov/Data/RuralUrbanContinu

umCodes/ 

US Department of Agriculture’s RuralUrban Continuum Codes (Beale codes): 

Provides urban rural code for all counties 

in US.

www.census.gov/hhes/www/saipe/index.html Census Bureau’s Small Area Poverty 

Estimates: Provides data on poverty and 

population estimates by county for all 

states except Puerto Rico.
59

WEBSITE ADDRESS EXPLANATION

www.census.gov/main/www/cen2000.html Census Bureau’s American Fact-finder: 

Provides all 1990 and 2000 census data 

including estimates on poverty, per 

capita income and unemployment by 

counties, states, and metro areas 

including Puerto Rico.

www.bls.gov/lau/home.htm Bureau of Labor Statistics’ Local Area 

Unemployment Statistics (LAUS): 

Provides data on annual and monthly 

employment and unemployment by 

counties for all states including Puerto 

Rico.

http://www.ers.usda.gov/Data/RuralUrbanContinu

umCodes/ 

US Department of Agriculture’s RuralUrban Continuum Codes (Beale codes): 

Provides urban rural code for all 

counties in US. 
60

ATTACHMENT L: Assurances and Certifications 

(eGrants Review, Authorize and Submit Section) 

Instructions

By signing and submitting this application, as the duly authorized representative of the applicant, you certify that the 

applicant will comply with the Assurances and Certifications described below. 

a) Inability to certify

Your inability to provide the assurances and certifications listed below will not necessarily result in denial of a grant. You 

must submit an explanation of why you cannot do so. We will consider your explanation in determining whether to enter 

into this transaction. However, your failure to furnish an explanation will disqualify your application.

b) Erroneous certification or assurance

The assurances and certifications are material representations of fact upon which we rely in determining whether to enter 

into this transaction. If we later determine that you knowingly submitted an erroneous certification or assurance, in addition 

to other remedies available to the federal government, we may terminate this transaction for cause or default.

c) Notice of error in certification or assurance

You must provide immediate written notice to us if at any time you learn that a certification or assurance was erroneous 

when submitted or has become erroneous because of changed circumstances.

d) Definitions

The terms ―covered transaction‖, ―debarred‖, ―suspended‖, ―ineligible‖, ―lower tier covered transaction‖, ―participant‖, 

―person‖, ―primary covered transaction‖, ―principal‖, ―proposal‖, and ―voluntarily excluded‖ as used in this clause, have the 

meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. An applicant 

shall be considered a ―prospective primary participant in a covered transaction‖ as defined in the rules implementing 

Executive Order 12549. You may contact us for assistance in obtaining a copy of those regulations.

e) Assurance requirement for subgrant agreements

You agree by submitting this proposal that if we approve your application you shall not knowingly enter into any lower tier 

covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation

in this covered transaction, unless authorized by us.

f) Assurance inclusion in subgrant agreements

You agree by submitting this proposal that you will obtain an assurance from prospective participants in all lower tier 

covered transactions and in all solicitations for lower tier covered transactions that the participants are not debarred, 

suspended, ineligible, or voluntarily excluded from the covered transaction.

g) Assurance of subgrant principals

You may rely upon an assurance of a prospective participant in a lower-tier covered transaction that is not debarred, 

suspended, ineligible, or voluntarily excluded from the covered transaction, unless you know that the assurance is erroneous. 

You may decide the method and frequency by which you determine the eligibility of your principals. You may, but are not 

required to, check the List of Parties Excluded from Federal Procurement and Nonprocurement Programs.

h) Non-assurance in subgrant agreements

If you knowingly enter into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or 

voluntarily excluded from participation in this transaction, in addition to other remedies available to the federal government, 

we may terminate this transaction for cause or default. 

i) Prudent person standard

Nothing contained in the aforementioned may be construed to require establishment of a system of records in order to render 

in good faith the assurances and certifications required. Your knowledge and information is not required to exceed that 

which is normally possessed by a prudent person in the ordinary course of business dealings.
61

ASSURANCES

As the duly authorized representative of the applicant, I certify, to the best of my knowledge and belief, that the applicant:

Has the legal authority to apply for federal assistance, and the institutional, managerial, and financial capability 

(including funds sufficient to pay the non-federal share of project costs) to ensure proper planning, management, and 

completion of the project described in this application.

Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the state, through any 

authorized representative, access to and the right to examine all records, books, papers, or documents related to the 

award; and will establish a proper accounting system in accordance with generally accepted accounting standards or 

agency directives.

Will establish safeguards to prohibit employees from using their position for a purpose that constitutes or presents the 

appearance of personal or organizational conflict of interest, or personal gain.

Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency.

Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728-4763) relating to prescribed standards 

for merit systems for programs funded under one of the nineteen statutes or regulations specified in Appendix A of 

OPM’s Standards for a Merit System of Personnel Administration (5 CFR 900, Subpart F).

Will comply with all federal statutes relating to nondiscrimination. These include but are not limited to: Title VI of the 

Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color, or national origin; (b) 

Title IX of the Education Amendments of 1972, as amended (20 U.S.C. 1681-1683, and 1685-1686). which prohibits 

discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), 

which prohibits discrimination on the basis of disability (d) The Age Discrimination Act of 1975, as amended (42 

U.S.C. 6101-6107), which prohibits discrimination on the basis of age; (e) The Drug Abuse Office and Treatment Act 

of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) The Comprehensive 

Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, 

relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) sections 523 and 527 of the Public Health 

Service Act of 1912 (42 U.S.C. 290dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug 

abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to 

nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the National 

and Community Service Act of 1990, as amended; and (j) the requirements of any other nondiscrimination statute(s) 

which may apply to the application.

Will comply, or has already complied, with the requirements of Titles II and III of the Uniform Relocation Assistance 

and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of 

persons displaced or whose property is acquired as a result of federal or federally assisted programs. These 

requirements apply to all interests in real property acquired for project purposes regardless of federal participation in 

purchases.

Will comply with the provisions of the Hatch Act (5 U.S.C. 1501-1508 and 7324-7328) which limit the political 

activities of employees whose principal employment activities are funded in whole or in part with Federal funds.

Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C 276a and 276a-77), the Copeland 

Act (40 U.S.C 276c and 18 U.S.C. 874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. 327-333), 

regarding labor standards for Federally assisted construction sub-agreements.

Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster 

Protection Act of 1973 (P.L. 93-234) which requires the recipients in a special flood hazard area to participate in the 

program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more.

Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of 

environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and 

Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands 

pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of 

project consistency with the approved state management program developed under the Coastal Zone Management Act 

of 1972 (16 U.S.C 1451 et seq.); (f) conformity of federal actions to State (Clean Air) Implementation Plans under 
62

Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C. 7401 et seq.); (g) protection of underground 

sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L. 93-523); and (h) protection of 

endangered species under the Endangered Species Act of 1973, as amended (P.L. 93-205).

Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C 1271 et seq.) related to protecting components or 

potential components of the national wild and scenic rivers system.

Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 

1966, as amended (16 U.S.C. 470), EO 11593 (identification and protection of historic properties), and the 

Archaeological and Historic Preservation Act of 1974 (16U.S.C. 469a-l et seq.).

Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and 

related activities supported by this award of assistance.

Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. 2131 et seq.) 

pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities 

supported by this award of assistance.

Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. §§ 4801 et seq.) which prohibits the use 

of lead based paint in construction or rehabilitation of residence structures.

Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act of 

1984, as amended, and OMB Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations.

Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, application 

guidelines, and policies governing this program.

Will comply with all rules regarding prohibited activities, including those stated in applicable Notice, grant provisions, 

and program regulations, and will ensure that no assistance made available by the Corporation will be used to support 

any such prohibited activities.

Will comply with the nondiscrimination provisions in the national service laws, which provide that an individual with 

responsibility for the operation of a project or program that receives assistance under the national service laws shall not 

discriminate against a participant in, or member of the staff of, such project or program on the basis of race, color, 

national origin, sex, age, political affiliation, disability, or on the basis of religion. (NOTE: the prohibition on religious 

discrimination does not apply to the employment of any staff member paid with non-Corporation funds or paid with 

Corporation funds but employed with the organization operating the project prior to or on the date the grant was 

awarded. If your organization is a faith-based organization that makes hiring decisions on the basis of religious belief, 

your organization may be entitled, under the Religious Freedom Restoration Act, 42 U.S.C. § 2000bb, to receive 

federal funds and yet maintain that hiring practice, even though the national service legislation includes a restriction on 

religious discrimination in employment of staff hired to work on a Corporation-funded project and paid with 

Corporation grant funds. (42 U.S.C. §§ 5057(c) and 12635(c)). For the circumstances under which this may occur, 

please see the document ―Effect of the Religious Freedom Restoration Act on Faith-Based Applicants for Grants‖ on 

the Corporation’s website at: http://www.usdoj.gov/archive/fbci/effect-rfra.pdf.

Will comply with all other federal statutes relating to nondiscrimination, including any self-evaluation requirements. 

These include but are not limited to: (a)Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits 

discrimination on the basis of race, color, or national origin; (b) Title IX of the Education Amendments of 1972, as 

amended (20 U.S.C. 1681-1683, and 1685-1686). which prohibits discrimination on the basis of sex; (c) Section 504 of 

the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), which prohibits discrimination on the basis of handicaps 

(d) The Age Discrimination Act of 1975, as amended (42 U.S.C. 6101-6107), which prohibits discrimination on the 

basis of age; (e) The Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to 

nondiscrimination on the basis of drug abuse; (f) The Comprehensive Alcohol Abuse and Alcoholism Prevention, 

Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of 

alcohol abuse or alcoholism; (g) sections 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 

and 290 ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the 

Civil Rights Act of 1968 (42 U.S.C. 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or 

financing of housing; and (i) the requirements of any other nondiscrimination statute(s) which may apply to the 

application.

Will provide, in the design, recruitment, and operation of any AmeriCorps program, for broad-based input from – (1) 

the community served, the municipality and government of the county (if appropriate) in which the community is 

located, and potential participants in the program; and (2) community-based agencies with a demonstrated record of 
63

experience in providing services and local labor organizations representing employees of service sponsors, if these 

entities exist in the area to be served by the program; 

Will, prior to the placement of participants, consult with the appropriate local labor organization, if any, representing 

employees in the area who are engaged in the same or similar work as that proposed to be carried out by an 

AmeriCorps program, to ensure compliance with the nondisplacement requirements specified in section 177 of the 

NCSA; 

Will, in the case of an AmeriCorps program that includes or serves children, consult with the parents or legal guardians 

of children in developing and operating the program;

Will, before transporting minor children, provide the children’s parents or legal guardians with the reason for the 

transportation and obtain the parent’s or legal guardian’s permission for such transportation, consistent with state law; 

Will, in the case of an AmeriCorps program that is not funded through a State, consult with and coordinate activities 

with the State Commission for the state in which the program operates.

Will ensure that any national service program carried out by the applicant using assistance provided under section 121 

of the National and Community Service Act of 1990 and any national service program supported by a grant made by 

the applicant using such assistance will address unmet human, educational, environmental, or public safety needs 

through services that provide a direct benefit to the community in which the service is performed; 

Will comply with the nonduplication and nondisplacement requirements set out in section 177 of the National and 

Community Service Act of 1990, and in the Corporation’s regulations at § 2540.100;

Will comply with the grievance procedure requirements as set out in section 176(f) of the National and Community 

Service Act of 1990 and in the Corporation’s regulations at 45 CFR § 2540.230;

Will provide participants in the national service program with the training, skills, and knowledge necessary for the 

projects that participants are called upon to perform, including training on prohibited activities; 

Will provide support services to participants, such as information regarding G.E.D. attainment and post-service 

employment, and, if appropriate, opportunities for participants to reflect on their service experiences; 

Will arrange for an independent evaluation of any national service program carried out using assistance provided to the 

applicant under section 121 of the National and Community Service Act of 1990 or, with the approval of the 

Corporation, conduct an internal evaluation of the program; 

Will apply measurable performance goals and evaluation methods, which are to be used as part of such evaluation to 

determine the program’s impact on communities and persons served by the program, on participants who take part in 

the projects, and in other such areas as required by the Corporation; 

Will ensure the provision of a living allowance and other benefits to participants as required by the Corporation; 

Has not violated a Federal criminal statute;

If a state applicant, will ensure that the State subgrants will be used to support national service programs selected by the 

State on a competitive basis;

If a state applicant, will seek to ensure an equitable allocation within the State of assistance and approved national 

service positions, taking into consideration such factors as the locations of the programs, population density, and 

economic distress;

If a state applicant, will ensure that not less than 60% of the assistance will be used to make grants to support national 

service programs other than those carried out by a State agency, unless the Corporation approves otherwise. 

CERTIFICATIONS

Certification – Debarment, Suspension, and Other Responsibility Matters
64

This certification is required by the government-wide regulations implementing Executive Order 12549, Debarment and 

Suspension, 2 CFR Part 180, Section 180.335, What information must I provide before entering into a covered transaction with a 

Federal agency? 

As the duly authorized representative of the applicant, I certify, to the best of my knowledge and belief, that neither the 

applicant nor its principals: 

Is presently excluded or disqualified; 

Has been convicted within the preceding three years of any of the offenses listed in § 180.800(a) or had a civil 

judgment rendered against it for one of those offenses within that time period; 

Is presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) 

with commission or any of the offenses listed in § 180.800(a); or

Has had one or more public transactions (Federal, State, or local) terminated within the preceding three years for cause 

or default.

Certification – Drug Free Workplace

This certification is required by the Corporation’s regulations implementing sections 5150-5160 of the Drug-Free Workplace Act 

of 1988 (P.L. 100-690), 45 CFR Part 2545, Subpart B. The regulations require certification by grantees, prior to award, that they 

will make a good faith effort, on a continuing basis, to maintain a drug-free workplace. The certification set out below is a 

material representation of fact upon which reliance will be placed when the agency determines to award the grant. False 

certification or violation of the certification may be grounds for suspension of payments, suspension or termination of grants, or 

government-wide suspension or debarment (see 45 CFR Part 2542, Subparts G and H). 

As the duly authorized representative of the grantee, I certify, to the best of my knowledge and belief, that the grantee will 

provide a drug-free workplace by: 

A. Publishing a drug-free workplace statement that:

a. Notifies employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled 

substance is prohibited in the grantee’s workplace;

b. Specifies the actions that the grantee will take against employees for violating that prohibition; and 

c. Informs employees that, as a condition of employment under any award, each employee will abide by the 

terms of the statement and notify the grantee in writing if the employee is convicted for a violation of a 

criminal drug statute occurring in the workplace within five days of the conviction; 

B. Requiring that a copy of the statement described in paragraph (A) be given to each employee who will be engaged in 

the performance of any Federal award; 

C. Establishing a drug-free awareness program to inform employees about: 

a. The dangers of drug abuse in the workplace;

b. The grantee’s policy of maintaining a drug-free workplace; 

c. Any available drug counseling, rehabilitation, and employee assistance programs; and

d. The penalties that the grantee may impose upon them for drug abuse violations occurring in the workplace;

D. Providing us, as well as any other Federal agency on whose award the convicted employee was working, with written 

notification within 10 calendar days of learning that an employee has been convicted of a drug violation in the 

workplace; 

E. Taking one of the following actions within 30 calendar days of learning that an employee has been convicted of a drug 

violation in the workplace: 

a. Taking appropriate personnel action against the employee, up to and including termination; or

b. Requiring that the employee participate satisfactorily in a drug abuse assistance or rehabilitation program 

approved for these purposes by a Federal, State, or local health, law enforcement, or other appropriate 

agency; 

F. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (A) 

through (E). 
65

Certification - Lobbying Activities

As required by Section 1352, Title 31 of the U.S. Code, as the duly authorized representative of the applicant, I certify, to the best 

of my knowledge and belief, that:

No federal appropriated funds have been paid or will be paid, by or on behalf of the applicant, to any person for 

influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer of 

Congress in connection with the awarding of any federal contract, the making of any federal loan, the entering into 

of any cooperative agreement, or modification of any federal contract, grant, loan, or cooperative agreement;

If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or 

attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of 

Congress, or an employee of a member of Congress in connection with this federal contract, grant, loan, or 

cooperative agreement, the applicant will submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in 

accordance with its instructions;

The applicant will require that the language of this certification be included in the award documents for all 

subcontracts at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative 

agreements) and that all subrecipients will certify and disclose accordingly. 

Erroneous certification or assurance

The assurances and certifications are material representations of fact upon which we rely in determining whether to enter into this 

transaction. If we later determine that you knowingly submitted an erroneous certification or assurance, in addition to other

remedies available to the federal government, we may terminate this transaction for cause or default.

Notice of error in certification or assurance

You must provide immediate written notice to us if at any time you learn that a certification or assurance was erroneous when 

submitted or has become erroneous because of changed circumstances.

Definitions

The terms ―debarment‖, ―suspension‖, ―excluded‖, ―disqualified‖, ―ineligible‖, ―participant‖, ―person‖, ―principal‖, ―proposal‖, 

and ―voluntarily excluded‖ as used in this document have the meanings set out in 2 CFR Part 180, subpart I, ―Definitions.‖ A 

transaction shall be considered a ―covered transaction‖ if it meets the definition in 2 CFR part 180 subpart B, ―Covered 

Transactions.‖ 

Assurance requirement for subgrant agreements

You agree by submitting this proposal that if we approve your application you shall not knowingly enter into any lower tier 

covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in 

this covered transaction, unless authorized by us.

Assurance inclusion in subgrant agreements

You agree by submitting this proposal that you will obtain an assurance from prospective participants in all lower tier covered 

transactions and in all solicitations for lower tier covered transactions that the participants are not debarred, suspended, ineligible, 

or voluntarily excluded from the covered transaction.

Assurance of subgrant principals

You may rely upon an assurance of a prospective participant in a lower-tier covered transaction that is not debarred, suspended, 

ineligible, or voluntarily excluded from the covered transaction, unless you know that the assurance is erroneous. You may 

decide the method and frequency by which you determine the eligibility of your principals. You may, but are not required to, 

check the List of Parties Excluded from Federal Procurement and Nonprocurement Programs.

Non-assurance in subgrant agreements

If you knowingly enter into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily 

excluded from participation in this transaction, in addition to other remedies available to the federal government, we may 

terminate this transaction for cause or default. 

Prudent person standard

Nothing contained in the aforementioned may be construed to require establishment of a system of records in order to render in 

good faith the assurances and certifications required. Your knowledge and information is not required to exceed that which is 

normally possessed by a prudent person in the ordinary course of business dealings.

Certification - Grant Review Process (State Commissions Only)

I certify that in conducting our review process, we have ensured compliance with the National and Community Service Act of 

1990, the Corporation's peer review requirements, and all state laws and conflict of interest rules.
66

ASSURANCES AND CERTIFICATIONS

ASSURANCE SIGNATURE: NOTE: Sign this form and include in the application.

SIGNATURE:

By signing this assurances page, you certify that you agree to perform all actions and support all 

intentions in the Assurances section.

Organization Name:

Program Name: 

Name and Title of Authorized Representative: 

Signature: 

Date: 

CERTIFICATION SIGNATURE: NOTE: Sign this form and include in the application.

SIGNATURE:

By signing this certification page, you certify that you agree to perform all actions and support all 

intentions in the Certification sections of this application. The three Certifications are:

Certification: Debarment, Suspension and Other Responsibility Matters

Certification: Drug-Free Workplace

Certification: Lobbying Activities

Organization Name:

Program Name: 

Name and Title of Authorized Representative: 

Signature: 

Date: 
67

ATTACHMENT M: Beneficary Populations

(eGrants Performance Measures Section)

BENEFICIARY POPULATIONS

Communities of Color

Low-income Individuals

Members of Faith-based Communities

Native Americans 

New Americans

Older Americans

People with Disabilities

Rural Residents

Veterans, Active Military, or their Families