My AmeriCorps - Registration

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The form contains the following errors:

Your first name is a required field.

Your last name is a required field.

Your social security number is a required field.

Your date of birth is a required field.

Your email address is a required field.

Your email address confirmation is a required field.

Create Profile: Step 1 of 4

Before you get started making a profile, learn more about all of the AmeriCorps programs here.

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Please use the following fields to create a profile. Enter your name exactly as it appears on your government-issued identification. Also, you must have a valid e-mail address. An asterisk (*) denotes a required field.
Prefix:
Preferred Name:
* First Name:
Middle Name/Initial:
* Last Name:
Suffix:
* SSN:	eg. 123456789
This page of the form requests your SSN to (a) confirm your citizenship status for eligibility purposes and/or (b) send you a payment that must also be reported to the Internal Revenue Service using your SSN. This request is voluntary, but not providing your SSN may affect your ability to become a Member and/or receive payments. It is requested pursuant to 42 U.S.C. Chapter 129 - National and Community Service, 42 U.S.C. Chapter 66 - Domestic Volunteer Services, and Executive Order 9397, as amended.
* Date of Birth:	(mm/dd/yyyy)
* E-mail Address:
* Re-enter E-mail Address:

Privacy Act Statement: AmeriCorps is required by the Privacy Act of 1974 (5 U.S.C. 552a) to tell you what personal information we collect via this website (e.g. name, contact information, demographics, education and employment history, criminal history, medical information) and how it will be used: Authorities ï¿½ My AmeriCorps requests your personal information pursuant to 42 U.S.C. Chapter 129 - National and Community Service, 42 U.S.C. Chapter 66 - Domestic Volunteer Services, and Executive Order 9397, as amended. Purposes ï¿½ It is requested to (1) manage your application, service, and post-service benefits and (2) evaluate how to enhance AmeriCorps. Routine Uses ï¿½ Routine uses of this information may include disclosure to complete your background check, to process your payments, to manage and oversee your service, and other reasons consistent with why it was collected. Effects of Nondisclosure ï¿½ This request is voluntary, but not providing the information may limit your ability to become a Member, continue being a Member, or receive Member benefits. Additional Information ï¿½ The applicable system of records notice is CNCS-04-CPO-MMF-Member Management Files (MMF) available via https://nationalservice.gov/privacy.

OMB Number 3045-0054


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