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# AmeriCorps **VISTA PROJECT**  **APPLICATION INSTRUCTIONS**

**OMB Control #: 3045**  **- 0038**  **Expiration Date: 5**  **/31/ 20**  **XX**2 

## IMPORT **AN T NOTICE**  These application instructions conform to the Corporation for National and Community Service ’s ( CNCS ) online grant application sy stem, eGrants. The eGrants sy stem is designed to serve CNCS ’s applicants and grantees. A ll CNCS funding announcements are posted on our web site www.cns.gov and at www.grants.gov . **Public Burden Statement** : The Paperwork Reduction Act of 1995 requires CNCS to inform all potential persons who are to respond to this collection of information that such persons are not required to respond unless it display s a currentl y valid OMB control number. (See 5 CFR 1320.5 (b)(2)(i) )
. **Time Burden** : The time required t o complete this collection of information is estimated to average 8 hours per applicant, including the time to review instructions ; search existing data resources ; gather the data needed; and complete and review the information collection before submitting
. **Use of Information** : The information collected constitutes an application to CNCS for resources . CNCS evaluates the application and makes award decisions
. **Effects of Non -**  **Disclosure** : Providing this information is voluntary ; however, failure to provide the information would not allow CNCS to assess the applicant’s request for resources . Therefore it would not be possible to consider awarding resources to the applicant
. **Privacy Act:** Information provided for this collection may be shared with federal, state, and local agencies for law enforcement purposes .

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## TA **BLE OF CONTENTS**

Important Notice
................................ ................................ ................................ ...................... 2 **A bout AmeriCorps VISTA**  **................................ ................................**  **................................ ..........**  **4 Application Process**  **................................ ................................**  **................................ ........................**  **4 Submitting Your Application in eGrants**  **................................ ................................**  **.................... 6**  I. Applicant Info
................................ ................................ ................................ .............. 6 II. Application In fo
................................ ................................ ................................ ........... 6 III. Narratives
................................ ................................ ................................ ..................... 7 IV . Project Plan
................................ ................................ ................................ ................ 11 V. Documents ................................ ................................ ................................ ................. 1 3 VI . Budget
................................ ................................ ................................ ........................ 1 3 VI I . Review, Authorize, and Submit
................................ ................................ ................. 1 4 **Application Instructions: Renewal/Continuation Requests**  **................................ ....................**  **1 6**  **A dditional Information**  **: Paper**  **copy forms ................................**  **................................ ..............**  **1 8** 4



## A **bout A meriCorps VISTA**  AmeriCorps VISTA is the national service program designed specifically to fight poverty
. VI STA supports efforts to alleviate povert y b y encouraging individuals from all walks of life to engage in a ye ar of full
- time service with a sponsoring organization to create or expand programs designed to bring individuals and communities out of povert y . Rather than providing cash grants, the VI STA program places individual VI STAs with sponsoring organizations
. R esources are provided to sponsors on an annual basis
. Invery limited circumstances, small grants may be available at the discretion of the CNCS State Office. VI STA provides a small living allowance and certain benefits for members . Sponsoring organizations absorb most of the costs related to project s upervision and logistical support. Investment by

the sponsoring organization and the community is fundamental to the VI STA program, as the VI STA resource is intended to be short
- term. 

## Ap **plication Process** Organizations interested in becoming a VISTA spo nsor should contact the CNCS State Office in their state and visit www.americorps.gov/vista
. CNCS 's State Offices are staffed b y federal employ ees . They conduct public outreach and program support and are directly responsible for developing and overseeing all VISTA projects within their state. **The CNCS**  **State Office is available to provide technical assistance.**  A directory of CNCS St ate Offices is available at **http://www.americorps.gov/about/contact/stateoffices.asp .**  To apply for VISTA resources, o rganizations complete a two
- step process: **Step 1**
**– AmeriCorps**  **VISTA Concept Paper** Organizations submit an AmeriCorps VISTA Concept Paper to CNCS . The Concept Paper is a preliminary screening tool that CNCS uses to evaluate whether the organization would be an appropriate sponsor. **Step 2 -**  **Am eriCorps VISTA Project Application**  If the Concept Paper is approved, the organization submits an AmeriCorps VI STA Project Application. The Project Application is based on the approved Concept Paper. CNCS provides Project App lication materials following approval of a Concept Paper. VI STA Concept Papers and Project Application s are submitted using eGrants, CNCS ’s integrated, secure, web
- based s ys tem for applications. Organizations must have an eGrants account to submit the Concept Paper and Project Application in eGrants. To create an account and access the eGrants s ystem, visit http://www.nationalservice.gov/egrants/index.asp
. Organizations that cannot submit using eGrants may submit in paper copy
. If you are submitting yo ur Concept Paper in paper cop y, you will find all the forms that you need in the Additional In formation section of these instructions
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**Ap plication**  **Instr uctions**  Please use the following AmeriCorps VI STA Project Application instructions if you are a new or re newing (continuing) applicant applying for VISTA resources. Onl y organizations with a CNCS - approved Concept Paper should complete th ese instructions
. In addition to consulting the CNCS State Office , as directed in these instructions, you may also consult the CNCS web site for resources targeted to applicants. **Selection Process and Criteria** The following criteria w ill be used by CNCS staff in the selection of AmeriCorps VI STA sponsors and in the approval of both new and renewal VI STA projects. Y our proposal must include all of the elements listed below. **Criteria for Sponsorship The organization m**  **ust:** Be a public sector organization or a private organization designated as non
- profit by the IRS. Have resources available for VISTAs to perform their tasks; ie, space, consumable supplies, telephone, on
- the
job transportation reimbursement; and be able to provide emergency cash advances when needed. Have the capacity and commitment to recruit, orient, train, supervise and otherwise support recruited Members in appropriate capacity
- building roles. Have an understanding of the concept of, and be committed to, the mission of VISTA. Be experienced in the issues related to the beneficiaries of service and those being addressed by the proposed project. Have the capacity to involve the beneficiary community in order to achieve project self
- sufficiency. Sign a Memorandum of Agreement that outlines the legal responsibilities of both parties. **Approval Considerations The project**  **application must:**  Address the needs of low
- income communities and otherwise comply with the provisions of the Domestic Volunteer Services Act Of 1973, (DVSA) as amended (42 U.S.C. 4951 et seq.) applicable to VISTA and all applicable published regulations, guidelines and CNCS policies. Lead to building organizational and/or community capacity to continue the efforts of the antipoverty project once VISTA resources are withdrawn. Describe in measurable terms the anticipated self
- sufficiency results at the conclusio n of the project, including results t o the sustainability of the project activities. Clearly state how VISTAs will be trained, supervised, and supported to ensure the achievement of program goals and objectives. Be internally consistent; The problem statement which demonstrates need, the project plan, the assignment, and all other components must be related logically to each other. Ensure that VISTA and community resources are sufficient to achieve project goals. Involve beneficiaries in project dev elopm ent and implementation throughout the life of the project as an advisory group Have the management and technical capability to implement the project successfully. Have an appropriate number of requested members for project goals ; the skills and qual ifications described in the application must be appropriate for the assignment(s). Ensures resources are available for VISTAs to perform tasks; i.e., space, consumable supplies, telephone, computer/internet access, in
- service transportation reimbursement; and be able to provide em ergency cash advances when needed. Requested the appropriate level of resources to achieve proposed goals and activities.6 Has capacity and commitment to recruit, orient, train, supervise and otherwise support recruited

Mem bers in appropriate capacity
- building roles. Has capacity to involve the beneficiary community in order to achieve project self
- sufficiency. 

## Submitting Your Application in eGrants The following instructions are for organizations submitting new applications. For organizations that are submitting a continuation (renewal) application, see Application Instructions: Renewal/ Continuation instructions on page 1 6 . Your application consists of the following components. Please make sure to complete eac h one. I. Applicant Info II. Applic ation In f

o III. Narratives IV. Project Plan V. Documents VI . Budget VIII . Review , Authorize and Submit Lo gin to eGrants. On c e you are in eGrants, before s tarting Section I, you will need to:  S elect “ View All Applications .” A screen will appear that lists all the applications that are in “Grantee Initial Entry” status that are associated with your account .  Your application, which was created when your Concept Paper was approved, will be listed as “VISTA State” or “VISTA Headquarters” under the Programs column
.  Write down the Application ID for later reference
.  Select “View/edit” next to your listing
. **I. A pplicant Info**  In eGrants, complete the Applicant Info Section. Some information is already in the s ys tem based on your Concept Paper. Please take the time to reflect your program activities accuratel y in this section.  Notice your name listed in the Applicant/User field indicating that you are the one who is curre ntl y logged in to eGrants . The Authorized Representative field list s the name of the staff person who authorized and certified the Concept Paper
.  In the Pro

ject Info Section , information about the project and project director will appear based on informat ion from the Concept Paper. S elect existing information o r enter new. In order to view or e dit details , click view/edit and update the information in the fields that appear.  Ensure that your organization’s EIN and DUNS numbers are listed correctly. **I I**  **. Ap**  **plicatio n**  **Info**7

In formation entered in the Applic ant Info , Application In fo , and Budget sections will populate the SF 424 Facesheet. If you are submitting your application in paper cop y, you will find all the forms that you need in the Additional Info rmation section at the end of the Application instructions on page 1 8 . If you have an y questions about how to respond to questions or the instructions are unclear, please contact your CNCS State Office. In eGrants, in th e Application Info Section:  Areas affected b y your pro ject are populated based on the Concept Paper
. You may edit this information if needed.  Enter proposed pro

ject start and end dates.  Indicate whether your application is subject to State Executive Order 12372. Indicate i f you are delinquent on any federal debt.  Select a Program Ty

pe by selecting from the Program Ty pe dropdown menu. Consult yo ur CNCS State Office if you are uncertain what to select
.  C heck the box next to Cost Share as appropriate
.  Once you c hoose and save the program ty pe and cost share indicator , the B udget sections 1 & 2 are created and added to the application. **III. Narratives**  The narrative section of the Application includes nine items. Each item has questions associated with it that you must answer. You addressed several of the Narrative items when you completed the Concept Paper. You can review and update those items as needed. Other Narrative items are new and must be completed for the first time . The following table lists which items were addressed in the Concept Paper
. **Narrative Item In Concept Paper**  Need Yes Strengthening Communities Yes Organizational Capacity Yes Project Management No Intermediary Justification Yes VISTA Assignment No Recruitment and Development No Other No Executive Summary No Summary of Accomplishments No8

Be sure to:  Type in the fields , single
- spaced.  Type both the question and answer. Use the same headings and numbering provided below.  Include activities for the entire project period for which you are requesting resources .  E nter information in each of the narrative fields in eGrants
. To enter information into the field, click **view/edit narrative** next to the corresponding narrative item an d type into the fields that appear.  You may wis h to first answer questions in a word processing document and then later paste them into the eGrants fields. This provides you with an offline, backup record. Avoid using special formatting or tables because eGrants does not accommodate them
. **Need** NOTE: The responses yo u submitted in the Concept Paper will copy over to the Application. Based on feedback from your CNCS State Office, you may wish to elaborate further. In this section describe the unmet pove rt y related community need(s) you propose to address using AmeriCorps VI STA resources. Ensure there is a clear connection between the stated poverty - related need, the local beneficiary community , the planned intervention activities, the activities of the VI STA members , and the final planned outcomes. Your narrative must include the following:  Data and statistics that are current, objective, and local, and that substantiate the need(s) in the geographic you plan to serve. Also cite the source of the data.  A description of wh y are the needs not being met now
.  H ow VISTAs would be used to meet those needs, and how man y VI STAs are you requesting.  A complete description of the specific low
- income population your project intends to serve  An explanation of how your proposed project relates to the current AmeriCor ps VI STA programming priorities from the current fiscal ye ar’s AmeriCorps VISTA Program Guidance. If it does not, provide a justification as to why not. **Strengthening Communities** In this section, d escri be how your VISTA p roject will complement or expand upon current efforts in the communit y to address the need(s) described previousl y . Your response should cover the following:  A description of how the project will be designed to build long
- term sustainab ility to ensure it has impact once VI STA resources end, including any evidence
- based approaches and their origin(s).  Discuss how this approach will change over time as the VI STA(s) implement the project and build capacity
.  How will your project ultimately strengthen the community and bring individuals out of poverty? **Organizational Capacity**9

Detail your organization’s capacit y to manage a federal national service program, including information based on the following questions:  What is your organization’s experience operating anti
- povert y programming in the identified area(s) of activity? Provide examples of past work in this area.  What community

partners will be engaged with the project and what are their roles ?  If your organization currently sponsors or has previously sponsored AmeriCorps members (including VISTAs) , please include a brief description of their assigned activities.  Describe how you will manage the project, and recruit and supervise the VISTA member(s). How w ill other staff or volunteers be involved in the project? What resources
-- including office and desk space, access to computer and phone , and other supplies
-- will you provide to the VI STA member(s )? **Project Management** In addition to the information pr ovided in the Concept Paper, describe your plan for providing daily supervision to the VI STA members assigned to the project. Include the following:  Name of the supervisor(s) indicating part or full time responsibility ;  Strategies you will employ to ensure members are prepared for their assignments and the ongoing support you will provide;  Plans for monitoring member(s)’ progress in meeting the assignments in their VISTA Assignment Description (VAD) relative to the project plan. If sites other than your organization will host/supervise VISTA members, please describe the nature of your organization’s relationship with them. Also provide your plan for coordinating supervision of those members assigned to other organizations (e.g., who at the site will be charged with supervision, etc.) VI STA requires that members of the low income community comprise at least 51% of your board of directors’ or an Advisory Council/group to provide guidance to overall project planning and implementat ion. Describe how you will ensure that the low income community has input into the project plan, execution of the project and ongoing support. If your board of directors meets this requirement, please indicate that in your plan. If it does not, please d escribe your plans for creating and utilizing an Advisory Council to meet the requirement. Please describe your plans for evaluating progress towards achieving your project’s projected outputs and outcomes. Include detail regarding measurement tools to b e used (e.g., survey s, databases, etc.), data tracking, collection, aggregation and the methods you will use to coordinate with any sub
- sites in evaluating performance. If appropriate, describe how you will collaborate with other national service programs (RSVP, Senior Companions, Foster Grandparents, or AmeriCorps State/National) to support your proposed project. (Note that VI STA members may not manage other CNCS supported grants or participants). You can contact your state office for a listing, if any , o f other national service programs in your proposed service area.10

**VISTA Assignment** Provide a summary

of the key objectives and activities the VI STA(s) and Leader(s) will perform to implement the proposed project. Please note that VI STA members and leaders serve for an entire year and the activities should be sufficient to enable the member to fulfill their one year full
- time commitment. These tasks and activities should logicall y align with the project goals yo u propose in the Performance Measures and the Community Needs sections. Please note the VISTA Assignment information will be used by approved projects as the basis for the VISTA Assignment Description to be created during the recruitment process. **Recruitment and Development** Describe your organization’s methods of recruiting qualified candidates. What kinds of skills should a VI STA bring to the position(s) in order to have a successful y ear? Federal law requires that VI STA sponsoring organizations make reasonable accommodat ions to meet the needs of qualified persons with disabilities wishing to serve as VISTAs. Describe how yo ur organization would provide reasonable accommodations to VI STAs with disabilities. Describe the service related transportation needs of the positi on. Please note service related transportation is travel outside of the member’s daily commute. Is it necessary for the candidate to have a privately

owned vehicle or is the position accessible via public transit or use of agency vehicle? How far might the VI STA travel on a monthly basis for service related commitments? What is your organizations’ reimbursement process for service related travel? Does your organization have the capacity to provide additional incentives, such as housing assistance? I f s o, provide detailed information in order to determine if the incentives are allowable based on VISTA regulations. Successful VISTA sponsors are expected to provide initial orientation and ongoing training. Describe plans for on
- site orientation to your organization and the community within the first month of service. Describe training opportunities, technical assistance and conferences that would be available to members throughout their service. If trainings, conferences, etc. would take place out of the state, the Corporation State Office must be notified in advance in order for review and approval of the training/travel plans and provided. **Intermediary Justification** If you are proposing a multi
- site or i ntermediary project, respond to the following. (If you are not requesting to become an intermediary sponsor, please leave blank.)  Describe the current, o bjective and local data/statistics that substantiate the proposed need(s) in each geographic area you plan to serve.  Provide information about sites and partners , if alread y identified ; if not identified, indicate how you will ensure that selected sites will fit within the overall project , Performance Measurement goal(s) and address the poverty
- related need as proposed.11  What is your organi zation’s history in selecting and managing other nonprofits or eligible agencies to receive resources and training from yo ur organization?  How will you monitor the sites for compliance with AmeriCorps VI STA rules and regulations as required in the Memorand um of Agreement? How will you monitor and hold intermediary

sites accountable for meeting program goals and providing member management information as required?  If the focus area(s) of the sites will not be the same and will not roll
- up into a single set o f performance measures, explain why an intermediary

sponsorship is necessary . Present a compelling plan to provide assistance or support to build site capacity, both in general and as it relates to the various focus area(s).  If sites will be required to pr ovide funds to your organization for inclusion in the project, provide the amount(s) and its intended use. **Other** If submitting an Amendment for Summer Associates as directed b y the Corporation, please include the proposed activities, and if applicable, l ist the placement sites (in the eGrants screen). **Executive Summary** Please provide a single paragraph summary (4
- 6 sentences) of your proposed VISTA project that includes: 1. A description of your organization’s mission. 2. The CNCS Programming Priority Area that your project aligns with. 3. A description of the proposed project goal(s) including who will benefit from the project. 4. The number of VI STAs and L eaders (if applicable) you are requesting and an overview of the major a ctivities they will perform. 5. The estimated length of time required to complete the project? You may use the following suggested template as a guide: [ **Organization Name** ]’s mission is [ **Mission Statement** ]. The proposed VI STA project aligns with the [ **Choose one CNCS Focus**  **Area** ] focus area. The VISTA project will seek to [ **enter goal(s)** ], and expects to benefit **[enter type and estimated number of beneficiaries]**  . **[Enter number of VISTA’s]** VI STA members will contribute to the goals of the project b y performing ac tivities such as **[enter activities]** over the course of **[enter expected length of project]. Summary of Accomplishments**  First time applicants: please leave blank
. Current VISTA sponsoring organizations seeking project renewal are required to complete this section . P rovide a description of the project’s accomplishments to date. Describe progress made towards the performance measures and an y goals/tasks provided in the narrative sections. 

### IV. Performance Measures In the performance measures module, you will navigate through different screens to:  Select a site and its capacity goal(s) and VISTA focus area(s)12  Create one or more performance measures for each capacity goal  Provide “anticipated” data for each of the pe rformance measures  Create Goal 1 performance measures that will map to the capacity building performance measures  Review and validate the information entered **Launch Link** If your CNCS State Office has authorized you to apply for Summer Associates, click in the check
- box to answer whether you are using Summer Associates for Capacity Building, Direct Service or Both. Then click in the appropriate check
- box if you will use Summer Associates to support the existing application. **Home Page**  To start the module, click the “Begin” button on the Home Page.  As you proceed through the module, the Home Page will summarize your work and provide links to edit the parts of the module you have completed. You may also navigate sections of the module using the screen featur e at the top of each page.  Once you have started the module, clicking “Continue Working” will return you to the screen you were on when you last closed the module.  After you have created at least one aligned performance measure, the Home Page will display a chart summarizing your measures. **Objectives Screen**  Select the first Priority Focus Area or Other Focus Area.  Select the Objective that aligns with your proposed project, e.g. financial literacy, housing.  Select Save to save and select additional Focus Area and Objective sets. **Capacity Building Screen**  Select Site (previously listed on the Site screen) and then select Project Year (1, 2, 3, etc.)  Select a Capacity

Goal from the list. I f you select other, enter the goal in the text box and then clic k on the “Add Cap Goal to L ist” button.  For CNCS Capacit y Goals, a list of the Service Activities will appear. Select as man y that apply to your project and this specific Capacit y Goal. For user
- entered Capacity Goals, select the Add User Service Activit y button to enter your own.  For CNCS Capacit y Building Outputs, a list of Outputs will appear. Select the one that applies to your project. For user
- entered Outputs, select the Add User Output button to enter your own.  In the Capacit y Building Data Collectio n section, select an Instrument from the drop
down list, and then enter a Description. Add the Target Number and the Unit of Measure.  If you have additional Capacity Building Outcomes to enter, repeat those steps.  Enter the Number of Requested VISTAs/Leade rs.  Once you have entered all your Capacit y Goals and Performance Measures set, select Map Goal 1 PMs to advance to the next screen.13

**Goal 1 to Goal 3 Mapping**  In the first section, select the Goal 1 Output from the list or add a user Goal 1 Output.  Next, select the Goal 1 Outcome from the list or add a user Goal 1 Outcome.  Finally , select a Program Strategy /Intervention from the list or add a user Program Strategy /Intervention.  OPTI ONAL: complete the Goal 1 Data Collection section by selecting the Instrume nt and entering a description. Next select the Target Number and Unit of Measure.  Repeat to enter additional Goal 1 Performance Measures.  Once selections have been made, select Add Goal 1 PM to Table. **Summer Associate Direct Service Screen** (only appears if Summer Associates are indicated on the Application screen)  Select Site, VI STA Priority Focus Area or other Focus Area, Objective from the drop
down menus. Enter total number of unduplicated Summer Associates requested.  Enter the Problem Statement describing the need for Summer Associates.  In the first section, select the Goal 1 Output from the list or add a user Goal 1 Output.  Next, select the Goal 1 Outcome from the list or add a user Goal 1 Outcome.  Finally , select a Program Strategy /Intervention from the list or add a user Program Strategy /Intervention.  MANDATORY: complete the Goal 1 Data Collection section by selecting the Instrument and entering a description. Next select the Target Number and Unit of Measure.  Repeat to enter additional Goal 1 Performance Measures.  Enter the number of Summer Associates who will specificall y work on this Performance Measure set.  Once selections have been made, select Add Summer Associate PM to Table. **Summary Screen** The summary

screen shows all of the informatio n you have entered in the module.  To print a summary

of all performance measures, click Print PDF for all Performance Measures.  To print one performance measure, expand the measure and select Print This Measure.  Select Edit Performance Measure to return to the Performance Measure screen.  Select Edit Data Collection to return to the Data Collection screen.

 Select Validate Performance Measures to validate this module prior to submitting your application.  Once the re are Performance Measure sets for each of the Sites listed in the application, select Validate Performance Measures to return to the main application. CNCS CNCS 

### V **. Documents**  In addition to your application submitted in eGrants, you are required to submit certain documents to CNCS in paper cop y, as part of your application as described below. Please submit the following documents to the appropriate State Office
.14  Copy of most recent financial audit if available.

 List of Advisory Group Members and their written comments about the application (not applicable if 51 percent or more of the persons on your board of directors’ members are of the low
- income community)
.
 Copy of Articles of Incorporation (not applicable to public entities)
.  List of Board of Directors, or governing body (not applicable if public entity) and their written comments about the application (comments not applicable if you created a separate Advisory Group that will submit written comments)
.  Organizational chart of the applying body
.  Tax exempt status: either IRS determination or copy of application to IRS for exemption (not applicable to public entities)
.  Copy of Supervisor’s Resume and Job Description
. For multi
- site projects, a list of organizations where memb ers will be placed , organization addresses , contact persons and contact information , copy of site supervisor’s resume and job description, and a letter of commitment from the Board of Directors of each organization
.  Negotiated Indirect Cost Agreement (if applying for a Program Grant )

 L etters of support for the proposed project from other organizations in your community. If the organization is a project partner, the letter should describe the type of support and/or resources the partner organiz ation will contribute. Contact the CNCS State Office with questions. 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”). 

### V **I .**  **Budget** All VI STA projects, regardless of ty pe, must complete the budget and include a written narrative justification for line item s . This includes standard VI STA projects for which no financial resources will be provided. While the re is no specific match requirement, the budget documents the type and level of resources the sponsor w ill provide to support the project
. NOTE: Several line items will be estimates ( for example, education award and stipend,) because they depend on a choice made b y each VISTA or Leader
. T hree budget worksheets are available , depending on the ty pe of project (Standard, Support, Program) for which you are appl yi ng. Please contact your CNCS State Office for the appropriate15

budget guidance for your project. Specific instructions on how to complete the budget will accompan y each of these forms
.

 **Part V I**  **.1** Standard VISTA Project Budget

 **Part V I**  **.2** Standard VISTA Project Budget with Support Grant

 **Part V I**  **.3** VI STA Program Grant Budget eGrants wil l create the budget and the budget narrative automaticall y from the detailed budget information you enter. Once you have entered your budget information in eGrants you will be asked to validate your budget, and eGrants will check your submission for error s. Do not include fractional amounts (cents). 

### VII **. Rev**  **iew , A**  **uthorize, 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 The Review section lists the information entered for the previous sections
. You can go back to any of these sections to review or change what you have entered, prior to submission. You can also view and print the informati on as a report. The report opens as an Adobe PDF Read
- onl y file. You may print the Concept Paper in PDF format or save a copy of it onto your computer. Because the PDF report is a read
- only file, you cannot ty

pe in the report. To make changes, you mu st edit in the eGrants system and run the report again for the updated version. Read the Authorization, Assurances, and Certifications carefully . Complete each section of the Assurances and Certifications. If you are submitting a paper cop y application, the Assurances and Certifications can be found in the Additional In formation Section. The person who authorizes the application must be the applicant’s authorized representative. This is the person who has the a uthorit y to commit resources at your organ ization. In order to complete this section, the appropriate staff person should logon to eGrants and go to the Auth orize and Submit section
. **The Authorized Representative must have his/her own eGrants account.**  To create an account and access the eGrants sy stem, visit http://www.nationalservice.gov/egrants/index.asp
.16

Be sure to check your entire application to make sure 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
.17



### Ap **plication Instructions:** 

## RENEW **AL /**  **CONTINU AT**  **ION REQUEST S**  The following instructions for submitting a renewal / continuation request apply onl y to existing sponsors with pro

jects that are currently

in their first ye ar in operation or more. **When to Submit Your Continuation Request:** Contact your CNCS State Office for specific timeframes. **How to Submit Y our Continuation Request:**   Submit your continuation request in eGrants.  To create your continuation request in eGrants, click **Continuation** 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** . The sy stem will copy your most recently

awarded application as a base to create your continuation application.  Select the correct NOFA.  Write down the Application ID for later reference.  Edit your continuation application as directed in the continuation request instructions below. When you have completed your edits, click the **SU BMIT**  button. If you have questions about the content of your continuation request, please contact your CNCS State Office
. **If you experience problems using eGrants, contact the eGrants Help Desk at (888) 677**  **- 7849.**  **What to Include in Your Con tinuation Request:**  **I. Applicant Info and Application Info** Update the Applicant Info and Application Info Sections in eGrants if necessary
. **Do not change the Project Name**  **or enter a new project .**  Select a Project Ty

pe. Check the cost share box, if appropriate. Consult your CNCS State Office i f you are uncertain of Program Ty pe or cost share
. **II. Narratives** Information will carry

over from the previous y ear. Describe an y updates or changes you are proposing to your pro

ject, as appropriate. **III. Performance Measures**  **IV. Documents**  Make status changes (“Sent,” “Not Applicable, ” or “Alread y on File at CNCS”) and submit the pape r copies to CNCS , as appropriate.18

T he following document should be submitted each y ear.
 L etters of support for the proposed project from other organizations in your community. If the organization is a project partner, the letter should describe the type of support and/or resources the partner organization will contribute. The other documents listed do not need to be submitted unless there are changes from the previous y ear. **IV. Budget** Provide a budget for the upcoming ye ar. Incorporate an y required CNCS increases, such as an increase to the member living allowance into your bud get. Your budget from the previous ye ar’s application is copied into your continuation request so you can make the necessary adjustments. Consult the Program Guidance, or other documentation provided by CNCS for any specific budget guidanc e .19



## Ad **ditional Information: Paper**  **copy forms**  If you are submitting your application in paper copy instead of eGrants , you will find the required SF424 forms (Facesheet) in the following section
. Be sure to:  Type, single
- spaced.  Use the same headings and lettering provided below when completing your application
.  Type both the question and answer.  Submit to the appropriate CNCS for National and Community Service State Office

**GENERAL SUBMISSION INSTRUCTIONS Application and Submission Requirements**  : Complete and return and the application to the CNCS State Office unless otherwise instructed. Number the pages of your submission consecutively. Do not submit the instructions as part of your applicati on.
 Part I: Facesheet, Assurances and Certifications (Modified Form 424)

 Part II: Narratives (All Sections)

 Part III: Performance Measures

 Part IV: Required Attachments

 Part V: Budget

– W ith accompanying budget narrative **Note:** Submission of a project application does not assure receipt of AmeriCorps VI STA resources.20 **PART I: FACESHEET INSTRUCTIONS** The facesheet is the standardized SF
- 424 form required for all federal grant/project applications. This form provides us with basic information about your organization and the type of project for which you are applying. The following instructions have been provided t o assist you in completing this form. 1. Filled in for your convenience 2. a. Enter the date b. is for CNCS State Office use only 3. a. and b. are for CNCS State Office use only (if applicable) 4. a. and b. are for CNCS State Office use only (if applicable) 5. Enter the following information: a. The complete name of the organization that will be legally responsible for the project. Not the name of the organizational unit within the legally responsible organization. (For example, indicate “National University” instead of “Liberal Arts Department.”) b. Enter the Organizational DUNS (Required. To obtain a DUNS number for your organization call: 1
- 866

- 705
- 5711

) c. Your organization’s complete address to include country and the 5 digit ZIP code d. 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. Enter the following information: a. Enter the appropriate letter in the box b. Consult the following list of characteristics of applicants and enter the corresponding numbers (all that apply) , each in a separate blank. 1. 2 - ye ar college 2. 4 - ye ar college 3. Area Agency on Aging 4. Chamber of Commerce/Business Association 5. Community Action Agency/Community Action Program 6. Community College 7. Community

–Based Organization 8. Faith
- based organization 9. Governor’s Office 10. Grant - making Entity Operating in Two or More States 11. Health Department 12. Hispanic Serving College or University 13. Historically Black College or University 14. Law Enforcement Agency 15. Local Affiliate of National Organization 16. Local Education Agency 17. Local Government municipal 18. National Non
- Profit (Multistate) 19. Other Native American Organization 20. Other State Government 21. School (K
- 12) 22. Self
- Incorporated Senior Corps Project 23. Service/Civic Organization 24. State Commission/Alternative Ad ministration Entity 25. State Education Agency 26. Statewide Association 27. Tribal Government Entity 28. Tribal Organization (non
- government 29. U.S. Territory 30. Vocational/Technical College 31. Volunteer Management Organization21

8. Check the appropriate box for the type of application and enter the appropriate letter(s) in the lower boxes a. Check “New” if you are applying for assistance for the first time or are reapplying for a new project/grant cycle b. Check “Continuation” if you are a grantee applying for second or third year funding within your 3
- year project period **( NOTE**  : For AmeriCorps*VISTA projects, check “New” to apply for a second or third year renewal to an existing MA ). c. Check “Revision” if you are a grantee proposing any change in your budget or requesting a no cost extension. 9. Filled in for your convenience 10. Filled in for your convenience 11. Enter the following: a. Enter the title of the project. Existing sponsors should use the same title as in their original or previous application b. Enter the name of the CNCS program initiative, if any, as provided in the instructions corresponding to the NOFA for which you are applying; otherwise leave blank. 12. List all areas affected by the project (e.g., counties and cities where the VISTA will be serving ) 13. Refer to Item #8

 If you have checked “New” application e nter the proposed Start and End Dates  If you have checked “Continuation” or “Revision” application, enter the dates of the approved project period 14. Estimated Funding: Enter the amount requested or to be contributed d uring this budget period on the 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 parenthesis.
a. **Federal** The total amount of Federal funds being requested in the budget b. **Applicant** The total amount of applicant share as entered in the budget c. **Local** NA d. **State** NA e. **Other** NA f. **Program Income**  NA g. **Total** The applicant’s estimate of the total funding amount for the agreement 15. Indicate if this application is subject to review by the state “Executive Order 12372 Process” by checking the box. Executive Order 12372, “Intergovernmental Review of Federal Programs,” was issued with the desire to foster the intergovernmental partnership and strengthen federalism by relying on state and local processes for the coordination and review of proposed federal financial assistance and direct Federal development. T he Order allows each state to designate and entity to perform this function. A list of these “Single Point of C ontact” entities can be found at: http://www.whitehouse.gov/omb/grants/spoc.html . Contact the Single Point of Contact to determine whether your application is subject to the state intergovernmental review process. a. If Yes, indicate the date a copy of your application was submitted to the state for review under the Executive Order 12372 Process b. If No, check the appropriate box. 16. Check the appropriate box. This question applies to the applicant organization , not the person who signs as22

the authorized representative. Categories of debt include delinquent audit allowances, l oans and taxes. If Yes, attach an explanation. 17. The person who signs this form must be the applicant’s legal represent ative. A c opy 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 of represent ations 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)
**STANDARD ASSURANCES AND CERTIFICATIONS** Once you have completed your AmeriCorps VI STA application, the Authorized Certifying Official for your organization is required to read and sign the Assurances and Certifications pages located on the pages following the facesheet
.23 **PART I -**  **FACESHEET APPLICATION FOR**  **FEDERAL ASSISTANCE** 2. DATE SUBMITTED TO CORPORATION FOR NATIONAL AND COMMUNITY SERVI CE (CNCS) Applicant I dentifier

1. TYPE OF SUBMI SSION: Application Construction Non - Construction Pre - application Construction Non - Construction 3. a. DATE RECEI VED BY STATE 3 b. State Application Identifier 4. a DATE RECEI

VED BY CNCS 4 b. CNCS Grant Number 5. APPLI CA

NT INFORMATION 5 a. L egal Name: 5.b. Organizational DUNS: 5.c Address: (

give street address, city, count, state and zip code) NAME AND CONTACT INFORMATION FOR PROJECT DIRECTOR OR OTHER PERSON TO BE CONTACTED ON MATTERS I NVOLVING THIS APPLI CATION (give area code) NAME: TELEPHONE NUMBER: ( )
- FAX NUMBER: ( )
- INTERNET E - MAIL ADDRESS: WEBSITE: 6. EMPLOYER IDENTIFICATION NUMBER (EI N):



### - 7. a TYPE OF APPLICANT: ( Enter appropriate letter in box: ) . I . State Controlled A. State I nstitution of Higher B. County Learning C. Municipal J. Private University D. Township K. I ndian Tribe E. I nterstate L. I ndividual F. I ntermunicipal M. Profit Organization G. Special District N. Other (Specify) H. I ndependent School O. Not for Profit District Organization Other (specify) 7 b. CNCS APPLI CANT CHARACTERI STICS Enter appropriate code in each blank:_____, _____, ______,______,_____ 8. TYPE OF APPLI CATION: New 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);

_________________________________________________ 10 CATALOG OF FEDERAL DOMESTI C A SSISTANCE NUMBER: **94**
**– 013**  TITLE (Name of Program): **AmeriCorps VISTA**  9. NAME OF FEDERAL AGENCY: **Corporation for National and Community Service** 11. a. TITLE OF APPLICANT’S PROJECT: 12. AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc): 11 b. CNCS PROGRAM I NITIATIVE (IF ANY): 13. PROPOSED PROJECT START DATE: **MM/DD/YYYY** END DATE: **MM/DD/YYYY** 14: ESTIMATED FUNDING a. Federal $ b. Applicant $ c. State $ N/A d. Local $ N/A e. Other $ N/A f. Program I

ncome $ N.A g. Total $ 15. I S APPLI CATION SUBJECT TO REVIEW BY STATE EX ECUTI

VE ORDER 12372 PROCESS? a. YES. THI S APPLI CATION WAS MADE AVAILABLE TO THE STATE EXECUTI

VE ORDER 12372 PROCESS FOR REVIEW ON: DATE:__________________________________________ B. NO. PROGRAM I S NOT COVERED BY E.O. 12372 OR PROGRAM HAS NET BEEN SELECTED BY STATE FOR REVIEW 16. I S THE APPLICANT DEL INQUENT ON ANY FEDERAL DEBT? Yes I f “Yes” attach an explanation. No 17. TO THE BEST OF MY KNOWLEDGE AND BELIEF , ALL DATA IN THIS APPLI CATION/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 I S AWARDE D. a. TYPED NAME OF AUTHORIZED REPRESENTATIVE: b. TITLE: c. TELEPHONE NUMBER: d. SIGNATURE OF AUTHORIZED REPRESENTATIVE: DATE SIGNED: Modified Standard Form 424
- (Rev 11/02 to conform to the CNCS eGrants system) OMB Control # 3045
- 0038 Expiration Date 5/31/201124 

## AS **SURA NCES**  As the duly authorized representative of the applicant, I certify, to the best of my knowledge and belief, that the applicant : 1. 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. 2. Will give the awarding agency, the Comp troller 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 a ccordance with generally accepted accounting standards or agency directives. 3. 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 inter est, or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the I ntergovernmental Personnel Act of 1970 (42 U.S.C. 4728 - 4763) relating to prescribed standard s 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). 6. Will comply with all federal statutes relating to no ndiscrimination. 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 I X 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 Alcoh ol 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. 7. 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 o f federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of federal participation in purchases. 8. Will comply with the provisions of the Hatch Act (5 U.S.C. 1501
- 1508 and 73 24 - 7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. 9. Will comply, as applicable, with the provisions of the Davis
- Bacon Act (40 U.S.C 276a and 276a
- 77), the Cope land 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. 10. Will comply, if applicable, with flood insurance purchase re quirements 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 a

nd acquisition is $10,000 or more. 11. 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 E xecutive 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 Section 176(c) of the Clean Air Act of 1955, as amende d (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). 12. 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. 13. Will assist the awarding agency in assuring compliance with Sectio n 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.). 14. 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. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89
- 544, as amended, 7 U.S.C. 2131 et se q.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance. 16. Will comply with the Lead
- Based Paint Poisoning Prevention Act (42 U.S.C. §§ 4801 et seq.) w hich prohibits the use of lead based paint in construction or rehabilitation of residence structures. 17. 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
- 13 3, Audits of States, Local Governments, and Non
- Profit Organizations. 18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, application guidelines, and policies governing this program.

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE AP PL ICANT ORGANIZATION DATE S UBMITTED25 **CERTIFICATIONS REGARDING (A) DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS; (B) DRUG**  **- FREE WORKPLACE REQUIREMENTS; AND (C) LOBBYING**  **A. Debarment,**  **Suspension, and Other Responsibility Matters** As required by the regulations implementing Executive Order 12549, Debarment and Suspension, implemented at 34 CFR Part 85, S ection 85.510, Participants’ responsibilities. A. As authorized representative of the applicant, I the applicant certify that neither the applicant nor its principals:

∙ Are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency.

∙ Has, wi thin a three
- ye ar period preceding this application, been convicted of, or had a civil judgment entered against them for commission of fra ud or other criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, Stat e or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, b ribery, falsification or destruction or records, making false statements, or receiving stolen p roperty.

∙ Is presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (2) (b) of this certification, and

∙ Has not, within a three
- year period preceding this application, had one or more public transactions (federal, state or local) terminated for cause or default; B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an explanation to this application. **B. Drug**  **- Free Workplace**  As required by the Drug
- Free Workplace Act of 1988, and implemented at 34 CFR Part 85, Subpart F. The regulations require certification by grantees, prior to award, that they will maintain a drug
- free workpl ace. 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, sus pension or termination of grants, or government
- wide suspension or debarment (see 34 CFR Part 85, Section 85.615 and 85.620). The applicant certifies that it has or will continue to: (a) Publishing a statement notifying employees that the unlawful man ufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the grantee’s workplace and specifying the actions that will be taken against employees for violation of such p rohibition; (b) Establish an ongoing drug
- fre e awareness program to inform employees about

— (1) the dangers of drug abuse in the workplace, (2) the grantee’s policy of maintaining a drug
- free workplace. (3) any available drug counseling, rehabilitation, and employee assistance programs, and (4) th e penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; (c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement req uired by paragraph (a) (d) Not ifying the employee in the statement required by paragraph (A) that, as a condition of employment under the grant, the employ ee will: (1) abide by the terms of the statement, and (2) notify the employer, in writing of his or her conviction for a violation conviction for a violation of any criminal drug statute occurring in the workplace no later than five days after such conviction (e) Notifying the agency in writing within ten days after receiving notice under subparagraph (d) (2)) from an employee or oth erwise receiving actual notice of such conviction; (f) Taking one of the following actions, within 30 days of receiving notice under subparagraph (d) (2), with respect to any emplo yee who is so convicted

— (1) Taking appropriate personnel action against su ch an employee, up to and including termination...; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; (3) Making a good faith effort to continue to maintain a drug
- free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f) **C. Certification** 
**– Lobbying Activities**  (a) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, 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 making of any federal grant, the entering into of any cooperative agreement, and the extension, renewal, amendment or modification of any federal grant, or cooperative agreement; (b) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attem pting 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 i n connection with this Federal grant or cooperative agreement, the undersigned shall complete and sub mit Standard Form
- LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions; (c) The undersigned shall require that the language of this certification be included in the award documents for all tiers (inclu ding subawards, subgrants, contra cts under grants and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. By signing this Certification page, you certify that you agree to perform all actions and support all intentions in the Certi fication sections of this application.

__________________________________________________________ ________________________ ____________________________________ Legal Applicant Printed Name and Title of Authorized Representative Signature of Authorized Representative ____________________________________________________ Date ______________26 **PA RT II. NA**  **RRA**

**T IVE**  **S** The purpose of the project narrative is for you to provide a concise and compelling justification for awarding the requested AmeriCorps VI STA members and/or Leaders. The narrative section of the Application includes nine items. Each item has questions associated with it that you must answer. The Narrative items and associated questions can be found on pages 7 - 11 Be sure to:  Submit a completed Face Sheet (SF424

– Application for Federal Assistance) with your project n arrative.  Type, single
- spaced.  Type both the question and answer.  Try to keep your response for each lettered section heading to no more than one page (250
- 400 words). **PA RT III.**  **PROJECT PLA N**  **Overview** The Project plan is composed of one or more **Action Plans**  . Each Action Pla n de scribe s the specific community need you plan to address, the goal and results you expect to achieve, and how you will assess your progress in achieving them. Complete the project plan template provided, being sure identify whi ch community need (s) ( identified in Narrative s, Need) will be addressed by them . Make copies of the template as needed. (Example of a completed Project Plan is attached). You may create additional Action Plans as appropriate for your project design. Example: An applicant proposes a project that has two different programming areas: 1. Starting a child care program for welfare to work recipients; and 2. Enhancing a job training and placement program for welfare to work recipients. The applicant may wish to create one Action Plan for each issue. The Action Plan may contain as many **P erformance**  **M**

**ilestones** as you want. While the **community need**, and the **goal statement** should cover a multi
- year period ( the estimated length of time required to complete the proposed project) , the **performance milestones** should only cover one year. In the action plan, clearly demonstrate:

 A realistic effort to help bring individuals and families out of poverty permanently; not simply to make poverty more tolerable;  Proposed project results that are measurable and convey the actual impact the project has on the individuals, families, and communities being served. **The Community Need statement:** Describe the specific need that will be addressed by the pro ject component included in this Action Plan. The need should be measurable and include a reliable source to establish the compelling nature of the need. **Goal Statement:** Describe the impact your project will have in addressing the community need identifie d above. This goal statement should cover the three
- year project period. **Performance Milestone (Expected Results)**  Describe what you hope to achieve in a particular activity area over the course of a 12
- month period.  The milestone should be directly related to the goal statement.  Include quantity or number (e.g. Complete 7 presentations at...)27

 One milestone per text box. Select “Add milestone” to include any additional milestones **Planned Period of Accomplishment:**  Indicate the project year and month that you expect this PM will be achieved
. **Indicator / Evidence of progress** : What are you tracking or measuring to determine if this result has been achieved? **Target:** Enter the same number (amount) or percentage that is described in the Performance Milestone above. If you enter a percentage target here, make sure you include the number (amount) in the Performance Milestone [e.g. 75 percent of volunteers (55 of 73) recruited ...] **How Measured** : Method by which accompli shment of target milestone will be determined
. **Description of data collection** : Description of data collection **:** process or measurement process (who collects it from whom and when/how often)
**Instructions Column A**  1. In the first row of column A, describe the community need to be addressed in relation to the problem(s) identified in your project narrative (Need)
. Examples are provided for your reference. 2. In the second section of column A, list the proposed project goal that you expect the AmeriCor ps VI STA s to achieve. In the Project Narrative, VISTA Assignment Description, you will include m ore specific tasks and activities for each member position you develop based upon these overall goals and a ctivities. 3. In the third section of column A, identify the expected results (Performance Milestones) , leading to the a chievement of the proposed goal. For each performance milestone , identify the indicators, targets, and how you will measure this result, and how you will collect the data. Report any data you have for this measure from prior years. **Column B** In column B, indicate the periods of time during which the member will work on and achieve the stated results. Performance milestones should be measured at least annually. **Column C** In column C, AmeriCorps VI STA projects report the progress on their performance milestones . Leave this blank until time for reporting.28 Column A **Am eriCorps**  **VISTA Project Plan** Column B **Date(s)** Column C **Community Need** : Describe the community need to be addressed in relation to the problem(s) identified in your project narrative (Need). Example: According to the Capital Area Workforce Center’s Annual Survey, currently only ten percent of unemployed clients in the region gain employment with the assistance of the Center 3 Years

**Goal Statement :**  Describe the impact your project will have in addressing the community need identified above. This goal statement should cover the three - year project period. **Example Goal**  1:. To help more clients secure jobs, AmeriCorps VI STA members will implement a job training and readiness program to serve clients from the region. Two hundred clients will receive training in year one; three hundred clients in year two; and five hundred clients in year three. 3 Years

**Performance Milestone** Participants will complete job training and readiness program. **Indicator:** Percentage o f participants who complete the training program (per year) **Target**: 75% (55 of 73) of people complete training program each year. **How Measured**

**:** attendance roster. **Description of Data Collection :**  VI STA me mber will collect attendance roster, which will be entered into a participant database maintained at the project site. January 201329 **Performance Milestone** Clients who complete job training and readiness program (program graduates) demonstrate improved job
- readiness skills. **Indicator:** Percentage of program graduates who improve in public speaking, interviewing, and resume writing. **Target** : **Year One** . Seventy - five percent of program graduates ( 42 of 55) improve in public speaking, interviewing and resume writing. **How Measured** : Jobs Readiness Skills. **Description of Data Collection :**  Jobs Readiness Skills Survey (pre
- test/post
- test), administered to training graduates by VISTA members. March 2013

**Performance Milestone** The employment rate will be higher for program graduates than for clients who do not participate in the program. **Indicator** : Percentages of program graduates and non
-participants who obtain employment **Target** : The employment rate will be at least ten percent higher for program graduates compared to non
- participants. **How Measured** : Employment data. **Description of Data Collection :**  Employment data, collected by the Workforce Center. July 201330 **ATTACHMENTS** Please submit the following attachments with your project narrative to the appropriate program office within the Corporation for National and Community Service.

 Copy of most recent financial audit if available.

 List of Advisory Group Members and their written comments about the application (not applicable if 51 percent or more of the persons on your board of directors’ members are of the low
- income community).

 Copy of Articles of Incorporation (not applicable to public entities).

 List of Board of Directors, or governing body (not applicable if public entity) and their written comments about the application (comments not applicable if you created a separate Advisory Group that will submit written comments).

 O rganizational chart of the applying body.

 Tax exempt status: either IRS determination or copy of application to IRS for exemption (not applicable to public entities).

 Copy of Supervisor’s Resume and Job Description. For multi
- site projects, a list of or ganizations where me mbers will be placed, organization addresses, contact persons and contact information, copy of site supervisor’s resume and job description, and a letter of commitment from the Board of Directors of each organization.

 Negotiated Indire ct Cost Agreement (if applicable)

 Letters of support for the proposed project from other organizations in your community. If the organization is a project partner, the letter should describe the type of support and/or resources the partner organization will contribute.31 **PA RT V.**  **BUDGET GENERA**  **L SUBMISSION I NSTRUCTIONS**  All VISTA projects must complete the SF 424A budget page and attach a written narrative justification for each line item
. While there is no specific match requirement, the budget documents the type and level of resources a sponsor will provide to support the project. NOTE: Several line items are estimates ( for example, education award and stipend) because they depend on a choice made by each VISTA or Leader
. Three budget worksheets are available , depending on the type of project for which you are applying. Please contact your CNCS State Office for the appropriate budget guidance for your project. Specific instructions on how to complete the budget will accompany each of these forms.

 **Part V I**  **.1** Standard VISTA Project Budget

 **Part V I**  **.2** Standard VISTA Project Budget with Support Grant

 **Part V I**  **.3** VI STA Program Grant Budget