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

PROJECT CONCEPT FORM Expiration Date: 10/31/2025

1 

APPLICANTINFORMATION

1 

Organization Name EIN 

Mailing Address

City State ZIP

Office Telephone Ext. 

Secondary Sponsor 

Organization Name EIN

Mailing Address

City State ZIP

Office Telephone Ext. 

2 Organization Type

 Community-Based 

Nonprofit Organization

 Federal Government

 Tribal Nation

 Local Government or Municipality

 National Nonprofit

 School

 State Government

3

Authorized Representative

Organizational Title

Phone Number Ext. 

Email Address

PROJECT INFORMATION

4

Project Title

Project Start Date Fixed or Flexible?

Project End Date Fixed or Flexible?

Estimated Completion

Time (Weeks) 

OTHER

5

How did you 

hear about 

AmeriCorps 

NCCC?

 I am an NCCC alum.

 I am a past NCCC Sponsor.

 I am a past NCCC Staff member.

 From an NCCC alum.

 From an NCCC Staff member.

 From a current NCCC member.

 From an AmeriCorps Office.

 From an AmeriCorps State or VISTA member.

 From a community partner.

 By email.

 On social media.

 On the AmeriCorps Website. 

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

PROJECT CONCEPT FORM Expiration Date: 10/31/2025

2 

ADDITIONAL QUESTIONS

8

Has your organization previously sponsored an 

AmeriCorps NCCC team? Yes No 

If ‘Yes,’ how many teams have served with your 

organization?

If ‘Yes,’ when did a team most recently serve with your 

organization?

9

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

10

Primary Area of 

Community Need

Energy Conservation

 Environmental Stewardship and Conservation

 Infrastructure Improvement

 Natural and Other Disasters

 Urban and Rural Development

6

Is your organization currently funded wholly or in part by AmeriCorps? Yes No

If ‘Yes,’ is the proposed project funded by an AmeriCorps State and National 

grant or any AmeriCorps VISTA resources? Yes No

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

those funds.

7

Will the proposed service replace any of your organization’s 

current or projected staff or contracted labor? Yes No
AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) OMB Control Number: 3045-0010 

PROJECT CONCEPT FORM Expiration Date: 10/31/2025

3 

NARRATIVES

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

PROJECT CONCEPT FORM Expiration Date: 10/31/2025

4 

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

PROJECT CONCEPT FORM Expiration Date: 10/31/2025

5 

LOCATIONS

PRIMARY LOCATION OF SERVICE 

13

Organization

Street Address

Address Line 2

City State ZIP

Accessible for people 

with disabilities? Yes No

Site Supervisor Name

Organizational Title

Email Address

Phone Number

PRIMARY LODGING SITE

14

Lodging Provider

Anticipated Arrival Date Anticipated Departure Date

Type of Lodging

 Apartment or Condo

 Armory

 Bed and Breakfast

 Cabin

 Campsite

 Church or Other Faith-Based 

Organization

 Community Center

 Dorm

 Short Term Rental

 Hostel

 Hotel

 Military Facility

 NCCC Campus

 Recreational Vehicle

 School Room or Classroom

 Summer Camp

 Vacant Home

 Volunteer Housing 

 Yurt

 Other 

Lodging Category

 Community or Faith-Based 

Organization

 Federal Government



Tribal Nation

 Institute of Higher Education

 Local Government or 

Municipality 

 Military

 National Nonprofit

 National or State Park

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

PROJECT CONCEPT FORM Expiration Date: 10/31/2025

6 

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

PRIMARY LODGING SITE (CONTINUED)

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.