AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC)

PROJECT CONCEPT FORM (PCF) 

 

1 

 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 

APPLICATION INFORMATION 

1 

Organization Name 

Mailing Address 

City State ZIP 

Office Telephone Ext. 

Secondary Sponsor 

Organization Name 

Mailing Address 

City State ZIP 

Office Telephone Ext. 

2 EIN Secondary 

Sponsor EIN 

• Community-Based Nonprofit Organization • National Nonprofit

• Federal Government • School

3 Organization Type 

• Indian Tribe • State Government

• Local Government or Municipality

4 

Authorized 

Representative 

Organizational Title 

Phone Number Ext. 

Email Address 

PROJECT INFORMATION 

5 

Project Start Date Fixed or Flexible? 

Project End Date Fixed or Flexible? 

Estimated Completed 

Time (Weeks) 

OTHER 

 I am an NCCC alum.  From an AmeriCorps State or VISTA member. 

 I am a past NCCC Sponsor.  From a community partner. 

6 

How did you 

hear about 

AmeriCorps 

NCCC? 











I am a past NCCC Staff member. 

From an NCCC alum. 

From an NCCC Staff member. 

From a current NCCC member. 

From a state CNCS office. 





By email. 

On social media (e.g. Facebook, Twitter, 

Instagram, YouTube, LinkedIn). 

On the CNCS Website. 

Other 
 

 

OTHER (CONTINUED) 

7 

Is your organization currently funded wholly or in part by the Corporation for 

National and Community Service? Yes No 

If ‘Yes,’ is the proposed project funded by 

grant or any AmeriCorps VISTA resources? 

an AmeriCorps State and National Yes No 

If ‘Yes,’ to either of the above questions, please provide detailed information concerning the funding 

those funds. 

source and utilization of 

8 Will the 

current 

proposed service 

or projected staff 

replace any of your organization’s 

or contracted labor? Yes No 

ADDITIONAL QUESTIONS 

Has your organization previously 

AmeriCorps NCCC team? 

sponsored an Yes No 

9 If ‘Yes,’ how many 

organization? 

teams have served with your 

If ‘Yes,’ when did 

organization? 

a team most recently serve with your 

10 

Has your organization ever had a “Fee-for-Service” 

arrangement with a Youth Corps or Conservation Corps 

program? 

 Yes No 

If ‘Yes,’ AmeriCorps NCCC has effectively been used in past projects to augment and support existing Youth 

Corps partnerships with organizations. Please describe how you plan to utilize the AmeriCorps NCCC team with 

your existing partnership with the “Fee-for-Service” Corps. 

PROJECT FOCUS AREAS 

 Energy Conservation 

 Environmental Stewardship and Conservation 

11 Primary Area of 

Community Need 

 Infrastructure Improvement 

 Natural and Other Disasters 

 Urban and Rural Development 

2 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) OMB Control Number: 3045-0010 

PROJECT CONCEPT FORM (PCF) Expiration Date: 10/31/2022 
12 Need 

3 

NARRATIVES 

 

 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) OMB Control Number: 3045-0010 

PROJECT CONCEPT FORM (PCF) Expiration Date: 10/31/2022 
4 

13 Project Design 

 

 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) OMB Control Number: 3045-0010 

PROJECT CONCEPT FORM (PCF) Expiration Date: 10/31/2022 
PRIMARY LOCATION OF SERVICE 

Organization 

Street Address 

Address Line 2 

City State ZIP 

Accessible for people 14 Yes No 

with disabilities? 

Site Supervisor Name 

Organizational Title 

Email Address 

Phone Number 

PRIMARY LODGING SITE 

Lodging Provider 

Anticipated Arrival Date Anticipated Departure Date 

 Apartment or Condo  Hotel 

 Armory  Military Facility 

 Bed and Breakfast  NCCC Campus 

 Cabin  Recreational Vehicle 

 Campsite  School Room or Classroom 

Type of Lodging  Church or Other Faith-Based  Trailer Organization 

 Vacant Home 

15  Community Center 

 Volunteering Housing  Dorm 

 Yurt  Homestay 

 Other  Hostel 

 Local Government or  Community or Faith-Based Municipality Organization 

 Military  Federal Government 

Lodging Category  National Nonprofit Organization  Indian Tribe 

 National or State Park  Institute of Higher Education 

 Other 

5 

 

LOCATIONS 

 

 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) OMB Control Number: 3045-0010 

PROJECT CONCEPT FORM (PCF) Expiration Date: 10/31/2022 
Street Address 

Address Line 2 

City State ZIP 

Accessible for people 

with disabilities? Yes No Beds provided? Yes No 

Full Kitchen (including 

stove and fridge) on site? Yes No 

If no full kitchen, 

microwave oven 

on site? 

Yes No 

Showers on site? Yes No Laundry on site? Yes No 

Please use the space provided below to further describe team lodging accommodations. 

 

 

 

PRIMARY LODGING SITE (CONTINUED) 

15 

SIGNATURE 

The Project Concept Form must be signed by a representative of the sponsoring organization. 

An electronic signature will be accepted. 

Project Sponsor Signature 

_______________________ 

Date 

________

 

 

 

_______________________________________ 

 

 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) OMB Control Number: 3045-0010 

PROJECT CONCEPT FORM (PCF) Expiration Date: 10/31/2022 

6