AmeriCorps Member File Checklist

Program Name: Program Year: 2013-2014 Member:

FOR EACH MEMBER FILE, INFORMATION SHOULD BE FILED IN THE ORDER INDICATED BELOW Are the following items in the member's file? YES NO AmeriCorps application Member enrollment form DATE SIGNED:

 Signed and dated by the member and the program director on or before the first day Are the followingof service items in the member's file? YES NO Parental Consent form [If the member is under 18 - Enter NA under NO if member is over age 18] MemberBackground Contract Check That [ALL Stipulates 3 ARE REQUIRED] The Following

DATE SIGNED:INITIATED:

Must be Signedinitiated by on theor before Member the firstand dayProgram of service. Director on or before the first day of service. NSOPR must be conducted on or before the first day of service. The contract must:  TheNational minimum Sex number Offender of service Public hours Registry and other (NSOPR)requirements (as developed by the Program) necessary  toState successfully Patrol Checkcomplete the term of service and be eligible for the education award.  FBIMinimum Background amount of educationCheck award Accompaniment Acceptable Documentation conduct [Enter NA in NO column if not applicable]  Prohibited activities Signed documentation Requirements of accompaniment under the Drug of the Free member Work forPlace any Act period between enrollment and receipt of the State Patrol & FBI backgroundSuspension checks. and termination Member must rules be accompanied by an individual who has passed the service site’s background checks.Circumstances in which members may be released for cause Tax Documents Grievance - W-4 Procedure form to document tax withholdings? (N/A to EAP)  Start and end dates of member’s term of service (to match WBRS) Employment Living Eligi allowancebility - Completed amount and how I-9 member will be paid Acceptable DocumentationSigned and dated by Of the Citizenshipmember and the / programNaturalization coordinator / prior Resident to initiation Alien of service Status PositionThis means Da escription photocopy of one of the following:  AAccurately birth certificate and completely showing that describes the individual the activities was bornto be in performed one of the by 50 the states, member the District of Colombia, Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, or the Northern Mariana Islands  Does not include or put the AmeriCorps member in a situation in which the member is at risk for  Aengaging U.S. passport in any prohibited activity (see 45 CFR § 2520.65),  ADoes report not of include birth abroad activity of thata U.S. would citizen violate (FS-240) the non-duplication issued by the State and non-displacementDepartment requirements (see  A45 certificate CFR § 2540.100), of birth- foreign or prohibited service fundraising (FS-545) issued activity by (seethe State45 CFR Department §§ 2520.40-45). High School A Diploma/GED certificate of naturalization  A certificate of citizenship (INS form N-560 or N-561) OR: PrimaryProof Documentation of High School Of Diploma Status orAs GED; A Lawful or Permanent Resident Of The U.S. One of the followingStatement isthat acceptable: member agrees to earn one prior to using education award *MemberPermanent self-certification resident card is sufficient (INS form effective I-551) 8/9/02. (See enrollment form or application) Time SheetsAlien registration card (INS form I-551)  MemberA passport signature indicating and that date the INS has approved it as temporary evidence of lawful admission for permanent  Appropriateresidence supervisor signature and date **Certification by Program Director that they have seen such documentation is sufficient,effective 8/9/02  Up to date Loan Forbearance Request  Track service hours, training, and fundraising hours separately  Evidence that the opportunity to forbear loans was offered to the member?  Program reconciles timesheets regularly to assure correctness (application or waiver) Completed Performance Evaluations Child Care [Full-time members only – for less than full-time positions mark NA in the NO column]  Mid Term + End-of-Term  At minimumEvidence includes: that the member was offered child care benefit? (application or waiver) Health Insurance- Service (full-time hour total members review only – for less than full-time positions mark “N/A” in the NO column) - AbilityEvidence to complete that the assignmentsmember was satisfactorily offered health insurance to be provided or made available by - Abilitythe program? to meet (applicationperformance criteriaor waiver) communicated at beginning of term - Did the member end his/her service with satisfactory performance Member End of Term / Exit Form  Member signature and date 2013-2014 CertifyingAmeriCorps official Member section File completedChecklist & signed 1  If a compelling circumstance was needed is there adequate documentation to show the need and approval?  Date on the form concurrent with the date the Member exited the program  Has the Program Director verified the number of hours served match the number of hours shown on the time logs? COMMENTS:

2013-2014 AmeriCorps Member File Checklist 2