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Enrollment Information
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| * State: |
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If you do not know your Zip plus four, please enter "0000".
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| * Mailing State: |
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If you do not know your Zip plus four, please enter "0000".
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Please answer all of the following questions. AmeriCorps gathers demographic information to ensure opportunities are provided to serve for people of all conditions. This information will be held confidentially, and will solely be used for data analysis to assist us in ensuring we serve all Americans equally. The information you provide will not be used in any way to determine or affect any federal benefit. Questions with an asterisk are required in order to be enrolled as an AmeriCorps member, and all responses will be kept confidential.
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| * Sex: |
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| * Citizenship Status: |
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*Citizens of the US include persons born in Puerto Rico, Guam, the US Virgin
Islands, and the Northern Mariana Islands. Nationals of the US include persons
born in America Samoa, including Swains Island.
**Generally, you are a Lawful Permanent Resident Alien of the US if you are a
US permanent resident with (i) a Permanent Resident Card, INS Form I-551; (ii)
an Alien Registration Receipt Card, INS Form I-551, (iii) a passport indicating
that the INS has approved it as temporary evidence of lawful admission for
permanent residence; or (iv) an I-94 indicating that the INS has approved it as
temporary evidence of lawful admission for permanent residence. NOTE: A student
visa does not confer eligibility to enroll in an AmeriCorps program.
*** You are an asylee if you have a Form I-94 with asylum granted stamp; form I-766
with Category "A5", "A05", or "A-5"; or an Order of the Immigration Judge granting asylum.
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| * What is the highest level of education you have completed?: |
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| What is the highest level of education completed by your mother?: |
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| What is the highest level of education completed by your father?: |
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| Which category represents the total combined income of all members of your family during the past 12 months? This includes money or income received by members of your family who are 15 years of age or older.: |
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| How confident are you that you could come up with $400 if an unexpected expense arose within the next month?: |
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* What is your military, veteran, or family member status? (Check all that apply):
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All Honorably Discharged veterans qualify for Nomination for the Presidents Volunteer Service Award.
I am a veteran
I am an active duty member of the U.S. Armed Forces
I am a member of the National Guard or Reserve Component
I am an immediate family member of a veteran
I am an immediate family member of an active duty member of the U.S. Armed Forces
I am an immediate family member of a National Guard Member or Reservist
I am not in the military, a veteran or a family member of someone in the U.S. Armed Forces
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| * Are you registered to Vote?: |
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| * Which of the following categories best describes your racial origin? (Check all that apply): |
American Indian or Alaska Native
Asian or Asian American
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other
Prefer Not to Respond
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| * Which of the following options best describes your ethnic origin?: |
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| * How did you hear about this program? (Check all that apply) |
Article (online, newspaper, or magazine)
Advertisement in a newspaper/magazine
Guidance counselor/teacher
Parent/relative
Current or former AmeriCorps Member
Friend told me/friend applied
TV commercial
Radio commercial
AmeriCorps recruiter/representative
Received information in the mail
AmeriCorps program poster
Other. Please specify
Recruitment brochure
College Resource Fair
Facebook ad or on Facebook in general
Twitter
Other social media platform.
Please specify:
AmeriCorps online recruitment system
Job search Web page
Service Commission
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