OneStar AmeriCorps VISTA ProjectHost Site Application

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IMPORTANT INFORMATION

Please review the Become a OneStar AmeriCorps VISTA Project Host webpage before starting your application.

Applications are due April 10, 2023 with a goal to place VISTA members by October 2023.

This Word document version of the application is provided as a resource to support organizations in developing the application. All applications must be submitted through this online form to be considered.

ORGANIZATION INFORMATION

Organization Name

Organization Federal EIN

Enter 9 digits, do NOT include spaces or dashes.

Organization Website URL

Organization Street Address

City

State

Zip Code

Organization Type:

Select the option that best describes your organization.

Have national service participants (AmeriCorps members or AmeriCorps Senior volunteers) ever served with your organization before?

YesNo

If you selected Yes, please complete the following chart:

Type of Members	Number of Members	Years Hosted	Description of Activities

Upload your organization's Tax ID Form or a letter showing the organization's tax status

CONTACT INFORMATION

First Name of Individual Completing this Application

Last Name of Individual Completing this Application

Position Title of Individual Completing this Application

Email

Phone

Is the contact listed above also the organization's authorized signatory?

The authorized signatory is a representative that is authorized to sign legal and fiscal agreements on behalf of the organization.

If the individual completing this application is NOT the organization's authorized signatory, please provide the following information.

Signatory First Name

Signatory Last Name

Signatory Position Title

Signatory Email

Signatory Phone

COST SHARE WAIVER

Is your organization financially able to contribute the $8,700 cost share contribution per VISTA member at this time?

If you selected No, limited cost share waivers may be available for qualifying programs in rural communities or for those projects focused on Disaster Services or Veterans and Military Families. How much is your organization able to contribute?

$4,350 (50% cost share waiver requested)$2,175 (75% cost share waiver requested)$0 (full cost share waiver requested)Other

If you selected Other, please specify:

VISTA PROJECT OVERVIEW

All narrative responses should be between 200 and 500 words.

ABOUT YOUR ORGANIZATION

State the mission of your organization.

What is the specific low-income population that your organization serves/plans to serve?

What is the poverty-related need that your organization is addressing? Include data points or statistics that support the need statement, with citations.

How is your organization addressing the identified poverty-related need?

ABOUT YOUR PROPOSED VISTA PLACEMENT(S)

Proposed AmeriCorps VISTA Position Title

What is the service area (e.g., city or county) of your proposed VISTA placement?

Describe the types of activities you expect the VISTA member to accomplish.

How will VISTA member build long-term sustainability at your organization, and how will this project be sustained after VISTA support ends?

Describe why you want this VISTA position at this time.

Describe how you will recruit for this AmeriCorps VISTA position.

MEMBER SUPERVISION - PROPOSED VISTA SUPERVISOR INFORMATION

First Name

Last Name

Position Title

Email

Phone

VISTA Assignment Counter

VISTA Assignment Count Total

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OneStar AmeriCorps VISTA Project
Host Site Application

VISTA PROJECT OVERVIEW

PROJECT SITE REQUIREMENTS