Pennserve Americorps State: Member Service Agreement Review

PennSERVE AmeriCorps State: Member Service Agreement Review Updated 07/24/17

Member Name: Program Name: Program Year:

Yes No Member Service Agreement Dates _____/______/______to ______/______/______Do the dates in the agreement match the dates in the Portal? Member Service Agreement contains all required elements  Citizenship and Eligibility Requirements for AmeriCorps members o A citizen of the United States, a United States national, or a lawful permanent resident of the United States o At least 18 years of age or 17 years of age with parental permission o Has a high school degree or equivalency certificate, or agrees to obtain a high school diploma or its equivalency before using the education award and the individual did not drop out of elementary or secondary school to enroll in the program

 Start and end dates of the member’s service term

 Member slot type and minimum number of service hours required Service Term Minimum # of Hours Full-time 1700 One-year Half-time 900 Reduced Half-time 675 Quarter-time 450 Minimum-time 300  The minimum number of hours per week that the member must serve based on their slot type and start date, and language that they may be exited from the program for failing to serve the required number of hours

 The maximum living allowance amount and description of all available benefits

 Explanation of how and when the living stipend will be paid, including the amount of each stipend payment

 Statement that benefits end upon member exiting service or may end if member changes term of service

 Education Award Amount and Guidelines are included and correct for the grant year Service Term Ed Award Full-time $5,815.00 One-year Half-time $2,907.50 Reduced Half-time $2,215.24 Quarter-time $1,538.36 Minimum-time $1,230.69 At a minimum, Education Award guidelines should include: o Language that, upon successful completion of the term of service, members are eligible for an education award commensurate with their agreed-upon term of service o Amount of the award for which the member is eligible PennSERVE AmeriCorps State: Member Service Agreement Review Updated 07/24/17

o Member must certify that he or she has completed high school or its equivalent or will obtain a high school diploma prior to using the education award o An education award must be used within seven years of the member completing the term of service o Members may earn the equivalent of two full-time education awards

 Loan Forbearance information

 Member service position description (This may be an attachment.)

 Statement that the member is aware that he/she may request a reasonable accommodation for a disability, including physical, emotional or mental disabilities

 Statement that the member may be deployed in times of emergency to provide disaster response

 Standards of conduct

 Full List of Prohibited activities (45 CFR 2520.65)

 Language encouraging members to vote

 Suspension and termination rules/ Explanation of Disciplinary Procedures

 The specific circumstances under which a member may be released for cause

 Grievance Procedures

 Non-duplication and Nondisplacement Language (45 CFR 2540.100)

 Language regarding Restrictions on fundraising by members (45 CFR 2520.40-45)

 Requirements under the Drug-Free Workplace Act

 Civil Rights requirements, complaint procedures, and rights of beneficiaries:

This program is available to all, without regard to race, color, national origin, disability, age, sex, political affiliation, or, in most instances, religion. It is also unlawful to retaliate against any person who, or organization that, files a complaint about such discrimination. In addition to filing a complaint with local and state agencies that are responsible for resolving discrimination complaints, you may bring a complaint to the attention of the Corporation for National and Community Service.

If you believe that you or others have been discriminated against, or if you want more information, contact:

PennSERVE Department of Labor & Industry 651 Boas Street, Room 1306 Harrisburg, PA 17121-0750 (866)6-SERVE-U (717) 705-4215 (FAX); [email protected]  Any other Nondiscrimination clause as required by a program’s parent organization

 Election/decline of healthcare

 Election/decline of childcare

 Written release/informed consent for publicity PennSERVE AmeriCorps State: Member Service Agreement Review Updated 07/24/17

 Other requirements established by the program Is it signed and dated by the member? Date signed ______/______/______Signed and dated by the program staff on or after member signed date? Date: ___/___/____ Is the program signature date concurrent or after the member signature? Is the member under 18?  If yes, is the contract signed and dated by the parent/guardian?

Signature of Reviewer: ______Date: ______