Home Energy Initiative Site Application

Site Name: *

AmeriCorps service typically takes place at non-profit, government, and/or educational institutions. Restrictions or additional policies may apply for AmeriCorps service at sites that are faith based/religious or for-profit entities. Please indicate whether the criteria below apply to your site.

Faith-based/religious

For-profit

Street Address *

Address Line 2

City *

State *

Zip Code *

Minnesota County *

County: *

Organization Information & Community Need

Briefly describe your organization's mission and vision. *

0/300 words

Help us better understand the population and community that the AmeriCorps member(s) will be serving through your organization. Please include information such as geographic reach, participant demographics, community need, and/or specific populations served. Please note any areas of environmental justice concern reached as indicated by the Minnesota Pollution Control Agency's Understanding Environmental Justice in Minnesota tool. *

0/300 words

Director Information

First Name *

Last Name *

Position Title *

Email Address *

Phone Number *

Site Supervisor Information

All AmeriCorps programs require a Site Supervisor to provide onsite support and supervision for each member placed. If you do not know who that is at this moment, please select “designate at a later time” and a staff member will work with you to identify this person. Otherwise, select "Enter Site Supervisor Info" and please fill in the information below.

Designate a Site Supervisor: *

Enter Site Supervisor Information

Designate at a later time

First Name *

Last Name *

Position Title *

Email Address *

Phone Number *

Recruitment Contact Information

Please identify a recruitment contact who will lead recruitment efforts at your site and serve as a point of contact for Climate Impact Corps staff. Partner sites are most successful in placing AmeriCorps members when they work alongside our staff to recruit from their community and networks.

Who will be your Recruitment Contact? *

Same as Director

Same as Site Supervisor

Someone else

First Name *

Last Name *

Position Title *

Email Address *

Phone Number *

Interview Information

We recommend that our staff complete final interviews on behalf of the site in order to streamline the process and avoid scheduling delays. That being said, if you would like a contact from your site to participate in the final interview alongside Climate Impact Corps staff, please check the box below:

Yes, my site would like to participate in the final interview.

Who will be your Interview Contact? *

Same as Director

Same as Site Supervisor

Same as Recruitment Contact

Someone else

First Name *

Last Name *

Position Title *

Email Address *

Phone Number *

AmeriCorps Member Request

AmeriCorps members with the Home Energy Initiative of Climate Impact Corps are referred to as Home Energy Members. Please consider the items below when determining your member request for the 2022-2023 program year (August 2022 - July 2023). If you have any questions related to your member request, please contact sites@ampact.us.

Need and variety of projects and activities, especially during the winter months
Any equipment, materials, or supplies needed (i.e. funds available for energy/weatherization)

Indicate the total number of full-time (40 hours/week) Home Energy Members requested by your site: *

Please describe the activities the requested AmeriCorps member(s) will perform with your organization. How will AmeriCorps service build the capacity of, but NOT replace, the work of existing staff? *

0/300 words

In three sentences or less, please describe what you're looking for in an AmeriCorps member. *

0/300 words

Will the member(s) be required to drive a car between site locations or within the community as a part of their service? *

Please list any other considerations or preferences related to your member request.

Site Fee Information

Please note: the question below is for informational purposes only and will not be used in the decision-making process to award sites.

Our goal is that there will be no cost to your organization outside of the time you need to devote to supervising the AmeriCorps member(s) and the supplies needed for the member to carry out their service. While federal AmeriCorps funding will cover 2/3 of the costs associated with each member, we must raise additional dollars to serve as a cash match to the federal dollars. Depending on the success of these efforts, it may be necessary to charge a fee to each site. A final decision about the need for a site fee will be made by summer 2022.

If a site fee is a barrier to participation in the program, please email sites@ampact.us to inquire about potential options for assistance.

*

My organization will be able to pay a fee of up to $10,000 per each member placed

My organization may not be able to pay a site fee and would like more information about potential scholarship opportunities

Click here if the billing contact for the Home Energy Corps site fee is someone other than the Director

First Name *

Last Name *

Position Title *

Email Address *

Phone Number *

Site Agreement Information

All Climate Impact Corps site partners must sign a site agreement outlining the partnership between the site and the program.

Click here if the contact to sign the Home Energy Corps Site Agreement is someone other than the Director.

First Name *

Last Name *

Position Title *

Email Address *

Phone Number *

Review & Submit

Please review the form before clicking the "Submit" button below to submit your application.

You will receive a copy of your application via email.