Americorps* PACC-VISTA 2010-2011

Pennsylvania Campus Compact AmeriCorps*VISTA Program 2012-2013 Host Site Application: Cover Sheet Due Monday, January 9, 2012 @ 12pm

Submission Instructions a

All documents should be submitted as one (1) .pdf—with your institution’s name as the title—via email to [email protected]. Additionally, please send Part C: Host Site Application Concept Paper as a separate .pdf. Deadline: Monday, January 9, 2012 @12pm. (Note: This is a change in process from previous years).

Applicant Information a

Applicant Institution:

Program Name (If applicable):

VISTA Supervisor’s Name:

VISTA Supervisor’s Title:

Address:

Telephone: Fax: Email:

Completed Application Checklist:

Host Site Application Cover Sheet Part A: Sections I-V Part B: Logic Model, VISTA Assignment Description, & Performance Measures (Specific to each program area) Part C: Host Site Application Concept Paper Letter of Support from College/University President Letter(s) of Support from at least one community partner Resume of Supervisor

Proposed Project Focus Area: Select one of the following service areas by checking the corresponding box.

Improving academic achievement of at-risk K-12 students Increasing college access for at-risk high school students Increasing food access for low-income families

Pennsylvania Campus Compact * 1 College Avenue, Box 4508 * Grantham, PA 17027 * (717) 796-5072 * F (717) 796-5078