Send completed application to College Bound COLLEGE BOUND Attn: AmeriCorps & Volunteer Program Manager 110 North Jefferson AmeriCorps Application St. Louis, MO 63103 August 2017 Phone: 314-361-4441 ext.109 Fax: 314-436-9210 Email: [email protected]
Applicant Information
Last Name First Name M.I.
Street Address City State Zip
Home Phone Number Cell Phone Number Email
Social Security Number Hometown
What position do you prefer? -FULL-TIME STATE AMERICORPS POSITIONS- -VISTA AMERICORPS POSITIONS- College Preparation Coach Development Associate College Completion Coach Financial Literacy Coordinator Alumni Relations Coordinator Data Systems Analysis Coordinator *While College Bound will note position preference; we reserve the right to offer each individual the opportunity best suited for them.
Are you a United States citizen, national, or lawful permanent resident alien? Yes No If you are a lawful permanent resident alien, what is your registration number and card expiration date?
Have you received your high school diploma or GED? Yes No Have you ever used any other name? Yes No Name(s) used: Have you ever been discharged from any position? Have you ever been convicted of a crime or violation other than a minor traffic violation? If yes, list all convictions, starting date, nature of offenses and where they occurred:
Other Information
How did you hear about these positions? Please check all that apply. Career Center Job Fair Tabling Professor/Instructor School List-Serve Flyer Postcard Class Presentation Idealist.org AmeriCorps.gov Craigslist Other website: Newspaper (please list): Other: College Bound Staff member or Board member Name: Supporter or Friend of College Bound Name: Optional Information
Providing the following information is optional. Ethnicity: How would you identify your family’s economic background? Are or were you a first generation college student? Yes No
Applicant Education
Date Dates Major/Minor/ Type of Degree Name of College or University City and State Received or Attended Course of Study or Certificate Expected
Military Experience Were you in U.S. Armed Forces? Yes No If yes, which service? Dates of service: Rank at separation: Duties:
Personal Statements Please answer the following questions. Feel free to continue beyond the indicated lines, but please try to limit your responses to no more than 300 words.
1. Why do you want to serve as an AmeriCorps Member with College Bound?
2. How have you been involved with or served in your community? Why dedicating a year of your life to service important to you? Please include what you hope to contribute during your year of service as an AmeriCorps member as well as what you hope to gain from the experience yourself.
3. Describe your thoughts regarding the right of all students to have equal access to higher education?
4. What kind of experiences have you had that you think have helped prepare you for working with diverse populations, including youth from low-income backgrounds?
5. Please share a quote that inspires you and explain.
References Professional references only. No friends or family please.
#1 Salutation & Reference Name Street Address City State Zip
Reference email Phone number Relationship
#2 Salutation & Reference Name Street Address City State Zip
Reference email Phone number Relationship
#3 Salutation & Reference Name Street Address City State Zip
Reference email Phone number Relationship Certification By signing below, I certify that all of the statements made in this application are true, correct, and complete, to the best of my knowledge, and are made in good faith. I understand that misinformation or omission of information could result in disqualification and/or termination as an AmeriCorps member. I also understand that my selection as an AmeriCorps member will require a National Criminal Background Check. I also indicate that I am prepared to serve a 12-month full-time term of service with College Bound from August 2015 to August 2016.
Signature (or typed name) Date
Send completed application to College Bound, Attn: AmeriCorps Coordinator, 110 North Jefferson, St. Louis, MO 63103 Email: [email protected] Phone: 314-361-4441 ext. 109 Fax: 314-436-9210
Materials needed to complete application: College Bound application Resume Cover Letter College transcript My.AmeriCorps.gov profile