TeamUP AmeriCorps Preliminary Application


  • Date Format: MM slash DD slash YYYY
  • City/State/Country
  • Date Format: MM slash DD slash YYYY
  • All information will be sent to this address unless you notify us of a change. (PLEASE INCLUDE A NUMBER AND STREET ADDRESS WHEN USING A P.O. BOX)
  • Please notify us of new address at time of move.
    Date Format: MM slash DD slash YYYY

  • (Indicate only one.)
  • Name of SchoolLocation of School (City/State)Major or Area of StudyType of Degree or CertificateDates Attended (From Mo./Yr. to Mo./Yr.) 
  • Community Service

    (Previous service is not always a requirement.)
  • Organization NameLocationPhoneDate of Involvement (From Mo./Yr. to Mo./Yr.)Hours per monthDescription of Involvement 
    (Your involvement could include serving in neighborhood, school, religious, social, professional, or other volunteer groups; helping out with community service projects; or participating in less formal activities.)
  • Which Program: AmeriCorps VISTA, AmeriCorps NCCC, or AmeriCorps State & NationalHow many times?Program or AmeriCorps NCCC Campus Location (city, state)Dates Served (From Mo./Yr. to Mo./Yr.)Did you complete your term of service?If no, why not? 
  • Motivational Statement

  • Employment

    Beginning with the most current or most recent position, list and briefly describe the last four positions you have held or your last ten years of employment you have held. Begin with the current or most recent and go back ten years. Include self-employment, internships/fellowships, home management, and full- or part-time paid or unpaid work experience. *** You may email a resume instead if it addresses the information requested below to***
  • OrganizationCity/StateDates Employed (From Mo./Yr. to Mo./Yr.)Hrs./weekTitleDutiesSupervisor Contact InfoReason for Leaving 
  • Skills and Experience

  • SkillHow Gained 
    Architectural Planning, Business/Entrepreneur, Communications, Community Org./Development, Computers/Technology, Conflict Resolution, Counseling, Education, Farming or Gardening, Fine Arts/Crafts, First Aid, Fundraising/Grant Writing, Leadership, Medicine, Outreach, Public Health, Public Speaking, Recruitment, Teaching/Tutoring, Trade/Construction, Writing/Editing, Youth Development, Other (specify)
  • LanguageNumber of Years Studied or SpokenSpeaking Ability: Poor, Fair, Good, ExcellentWriting Ability: Poor, Fair, Good, Excellent 
  • Economic Background

    AmeriCorps seeks to involve participants from all economic backgrounds. Please provide your current household information or that of the person claiming you as a dependent.
  • Criminal History

    The AmeriCorps application process requires a criminal history check to ensure community members with whom we work are protected, particularly children, individuals with disabilities, and individuals over 60 years old. We are investigating for past sexual offenses and violent crimes, or crime that would have a direct bearing on your service. This background check will entail our search of the National Sex Offenders Registry and an FBI criminal history check, which will require your being fingerprinted at Pre-Service Orientation. You will not be permitted to serve or work with children, individuals with disabilities, or individuals over 60 years of age, without supervision until the history check is complete and you are cleared. The review process is not lengthy, and normally is completed within weeks. Answer the following questions fully. Existence of a criminal conviction or juvenile adjudication may or may not, depending on the circumstances, disqualify you from consideration. However, any intentional misrepresentation or omission will disqualify you. Do not include minor traffic violations.
    If no, skip to “Certification” below. If you answered yes to any of the questions above, please provide the following information:
  • Date Format: MM slash DD slash YYYY
  • City, State
  • You may attach any additional information or explanation. Please email a copy to
  • The Corporation for National and Community Service programs are available to all without regard to race, color, national origin, disability, age, gender, sexual orientation, religion, political affiliation, or other non-merit factors. Anyone believing he or she has been subjected to discrimination on these grounds by the Corporation for National and Community Service, AmeriCorps, or one of its grantees may contact our Office of Civil Rights and Inclusiveness at (202) 606-7503 or email at
  • Certification

    If you choose to submit a paper application, your application must be certified with your original signature in ink. If you are applying to more than one AmeriCorps program, make a copy for each program that you’re applying to first, and then sign each one.