Prevention Resource Center
VISTA Site Application
Applications must be submitted in electronic format to [email protected] . Applications are accepted year round, however placement occurs twice annually: January and July. For placement in January 2018, applications may be received no later than September 1st. For placement in Summer 2018, applications may be received no later than March 2nd. Please complete the Prevention Resource Center’s Host Site Readiness document prior to completing this application.
General Information
Organization Information Organization Name Site Supervisor & Title Organization EIN Supervisor email Project Title Phone Number Website Fax Number Physical Address City, State, Zip +4 digit code Recruiting Contact Recruiter E-Mail (if different than Site Address Supervisor) Recruitment Cycle
What year will this VISTA project be?
Which of the following best describes your organization?
Organization Information What is your organization’s mission & vision?
H:\VISTA\LEADER\Sites\!PRC Site Application Updates\Host Site Application Packet!\PRC Site Application 2018 Page 1 of 7 What are the major programs and services of your organization?
*STOP: Have you completed the Host Site Readiness Assessment? If not, please go back & complete the Readiness Assessment* VISTA Host Site Details Please provide complete answers to each bullet.
City where member will serve: # of VISTAs requested: # of VISTAs that have served at this site in the past, with which project and in what capacity: Proposed primary CNCS Focus Area:
What is the overall goal of the project, what does your project want to achieve?
This is not a capacity building activity. It must align with Anti-Poverty Outcomes. Use program goal development on pg. 3. List populations to be served (remember you must track these throughout VISTA term):
Project Summary
Community Need Problem Statement a. What is the need/problem in the community you wish to resolve? Please describe. The need/problem statement is the root cause, not the strategy(s) needed. You MUST include quantitative data supporting community need and relate to it back to the overall goal.
Capacity Building
a. What Capacity will be built? Please include whether the activity is evidence-based.
b. Capacity-Building Outputs and/or Outcomes –Please list site-specific measurement chosen from pages 4 and 5 along with the deliverable capacity building activity. (i.e. Capacity Building Services – G3-3.4 (volunteer management and recruitment plan, and Mentoring program)
Anti-Poverty Statement
a. How will the project alleviate poverty? Be as specific as possible and provide evidence-based data. Complete the first sentence in the following format: This VISTA project will move _[fill-in]_ out of poverty by _[fill-in]_ resulting in _[fill-in]_.
Example first sentence: “This VISTA project will move at-risk youth of out poverty by providing mental health services resulting in higher success rates in school, work and life.”
Sustainability
a. How will the project be sustained when VISTA resources are no longer available?
H:\VISTA\LEADER\Sites\!PRC Site Application Updates\Host Site Application Packet!\PRC Site Application 2018 Page 2 of 7 Will the project increase/improve services to clients? What services will be added and/or how will they be improved? Please include baseline numbers and the number of NEW clients or NEW services to be served / implemented. Example: This project will increase service access by improving the support system directing and managing Program X. Who will this project serve? Veterans, children, children of incarcerated adults, at-risk households, New Americans, at-risk seniors, disabled citizens, etc. How will this project specifically alleviate poverty? Example: A total of 75 clients will have new access to mental health services through Project X this year. How specifically will the project impact those served? Example: Clients served through the new mental health program will be able to manage health conditions well enough to ensure high-school graduation success.
Anticipated Outcomes & Performance Measures
Performance Measures(PMs) The checked PMs are required for you to report. Choose up to an additional 3 site-specific PMs that best fit your project. The VISTA will report on selected performance measures in quarterly reports. Please ensure that the host site is able to measure selected outputs and outcomes; o Indicate data collection methods for EACH output and outcome. o Specify a target (number) for each output and outcome checked.
Data Collection Method
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July to July Member Timeline ☐
H:\VISTA\LEADER\Sites\!PRC Site Application Updates\Host Site Application Packet!\PRC Site Application 2018 Page 4 of 7 VISTA Assignment Objectives and Member Activities The first Objective is pre-filled out as it is required for every MT VAD. Please use the first Objective of the Assignment as a template for the rest of the VAD objectives. Each Objective must include activities related to the Goal of the Project. Each activity must reference the PM it supports. Please choose only the PMs previously indicated for your project from page 4-5.
Objective of the Assignment (July 2016-July 2017) The VISTA member will orient themselves to the Performance Measure requirements of the project in order to successfully implement each project component and accurately report on project progress. Member Activities: 1. The member will ensure that they receive Onsite Orientation and Training (OSOT) upon arrival at the host site and communicate any project questions to the host site supervisor and/or VISTA project sponsor. 2. The member must review the Performance Measures (PMs) applicable to the project. Full details of these PMs are available online at: http://www.nationalservice.gov/resources/performance-measurement/vista a. [Insert chosen Performance measure from page 4-5] b. [Insert chosen Performance measure from page 4-5] c. [Insert chosen Performance measure from page 4-5]
3. Upon understanding the reporting requirements of each PM, the member will determine and put in place the reporting tools needed to supply PM data to the VISTA project sponsor.
VISTA Assignment Description (VAD)
VISTA Assignment Objectives and Member Activities
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Objective of the Assignment (mm/dd/yyyy – mm/dd/yyyy) Description of Capacity Building Goal:
Member Activities:
1. Capacity Building Related Activity [G3-3.#] 2. Capacity Building Related Activity [G3-3.#] 3. Capacity Building Related Activity [G3-3.#]
Objective of the Assignment (mm/dd/yyyy – mm/dd/yyyy) Description of Capacity Building Goal:
Member Activities:
1. Capacity Building Related Activity [G3-3.#] 2. Capacity Building Related Activity [G3-3.#] 3. Capacity Building Related Activity [G3-3.#] ______
Objective of the Assignment (mm/dd/yyyy – mm/dd/yyyy) Description of Capacity Building Goal:
Member Activities:
1. Capacity Building Related Activity [G3-3.#] 2. Capacity Building Related Activity [G3-3.#] 3. Capacity Building Related Activity [G3-3.#]
Objective of the Assignment (mm/dd/yyyy – mm/dd/yyyy) Description of Capacity Building Goal:
Member Activities:
1. Capacity Building Related Activity [G3-3.#] 2. Capacity Building Related Activity [G3-3.#] 3. Capacity Building Related Activity [G3-3.#]
Objective of the Assignment (mm/dd/yyyy – mm/dd/yyyy) Description of Capacity Building Goal: Member Activities:
1. Capacity Building Related Activity [G3-3.#] 2. Capacity Building Related Activity [G3-3.#] 3. Capacity Building Related Activity [G3-3.#]
Please provide supported documents in the following order:
H:\VISTA\LEADER\Sites\!PRC Site Application Updates\Host Site Application Packet!\PRC Site Application 2018 Page 6 of 7 1. VISTA Position Description: You must include the following: knowledge, 2. skillsOn-Site and Orientation abilities; attributes; & Training VISTA (OSOT): duties; Must and Include physical demands includinga. The steps a statement you plan of to reasonable take to acquaint accommodation, the VISTA toto thebe consideredorganization,. community and project. b. Monday through Friday orientation schedule for the first 2 weeks of service that must be followed and completed. c. Host-Specific OSOT is required by the Corporation of National and Community Service. It is essential you provide a site orientation schedule and submit it.
3. Letter of support from your agency’s board of directors indicating: a. Support for the VISTA position to include the cost-share requirement, b. A commitment of at least 30 minutes per week of regularly scheduled feedback with the VISTA to ensure performance measure are on track and being met, c. An understanding of the VISTA’s role, d. The organization’s commitment to assuring a successful VISTA placement, e. Support working toward the goals, objectives and end outcomes of the proposed project.
4. A List of: a. Personnel structure, indicating any additional members included in VISTA contact. (Attach organizational chart if available) b. Board members and/or advisory council members. Attached
Keep in mind: VISTA cannot supplant paid staff work. Tasks and duties must fit VISTA parameters a. If participating in community prevention coalition, include coalitions & key members.
1. Site Assurances: please provide a statement of assurance that the site supervisor will: a. Participate in required PRC training events to include conference calls, PRC site visits, site supervisor webinars and trainings. b. Review and understand Host Site cost share responsibilities. c. Recruitment: contact a referred applicant within 48 hours of referral. This includes contacting the PRC VISTA Program Manager and/or VISTA Leader with an active update on referred applicants; otherwise they will be redirected to “VISTA ready” sites.
In submitting this application, I affirm that I have completed the Host Site Application in full, including: Host Site Readiness AssessmentSite Application Required Supporting documentsCompleted VA
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