AmeriCorps Instructor Application

MOTIVATIONAL STATEMENT
Please share with us why you would like to serve with the AmeriCorps program.

EMPLOYMENT HISTORY
YESNO
Beginning with the most current or most recent position, list and briefly describe up to the last four positions you have held, or your last ten years of employment you have had. Include self-employment, internships/fellowships, home management, and full- or part-time paid or unpaid work experience.
Organization
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Name
Supervisor Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Supervisor Email
example@example.com
Job Title
Job Duties
Reason for Leaving
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Hours Per Week
YESNO
Organization
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Name
Supervisor Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Supervisor Email
example@example.com
Job Title
Job Duties
Reason for Leaving
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Hours Per Week
YESNO
Organization
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Name
Supervisor Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Supervisor Email
example@example.com
Job Title
Job Duties
Reason for Leaving
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Hours Per Week
YESNO
Organization
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Name
Supervisor Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Supervisor Email
example@example.com
Job Title
Job Duties
Reason for Leaving
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Hours Per Week
Skills and Experience
Our program works with youth in Elementary and Middle-School and provides high quality science expereinces to youth. Please highlight or describe any experience you have in Science and working with youth.

COMMUNITY SERVICE/VOLUNTEER
Please list the organizations with which you've performed volunteer or community service. List your most recent activity first. Your involvement could include serving in neighborhood, school, religious, social, professional, or other volunteer groups; helping out with community service projects; or participating in less formal activities.
YESNO
Organization
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Description of involvement
Date of involvement from

MonthDayYear
Date
Date of involvement to

MonthDayYear
Date
Hours Per Month
YESNO
Organization
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Description of involvement
Date of involvement from

MonthDayYear
Date
Date of involvement to

MonthDayYear
Date
Hours Per Month
YESNO
Organization
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Description of involvement
Date of involvement from

MonthDayYear
Date
Date of involvement to

MonthDayYear
Date
Hours Per Month

LOAN FORBEARANCE
As an AmeriCorps member you may be eligible for forbearance on your qualified student loans during your term of service. Forbearance is granted by the Financial Institution, not by CNCS, and depends on both the Financial Institution and type of loan that you have. If you plan to place your student loans on forbearance, it is important to check with your Financial Institution because some types of loans may not qualify. I understand that I can find more information about loan forbearance on my.americorps.gov, and that links to CNCS sponsored help pages were provided in the Program Description PDF.

I understand that I am responsible for determining if my loans qualify for forebearanceDoes not apply

REFERENCES
Reference Name
Relationship to Applicant
Reference E-mail Address
example@example.com
Reference Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference Name
Relationship to Applicant
Reference E-mail Address
example@example.com
Reference Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

INTERVIEW TIMES
Monday, 9:00-12:00pm, Central TimeMonday, 1:00-6:00pm, Central TimeTuesday, 9:00-12:00pm, Central TimeTuesday, 1:00-6:00pm, Central TimeWednesday, 9:00-12:00pm, Central TimeWednesday, 1:00-6:00pm, Central TimeThursday, 9:00-12:00pm, Central TimeThursday, 1:00-6:00pm, Central TimeFriday, 9:00-12:00pm, Central Time
If unavailable, what other days (M-F) and times (9am-6pm, Central Time) would be better for you?
Should be Empty:

AmeriCorps Instructor Application

BASIC INFORMATION

MOTIVATIONAL STATEMENT

EMPLOYMENT HISTORY

EDUCATION

COMMUNITY SERVICE/VOLUNTEER

LOAN FORBEARANCE

DEMOGRAPHIC INFORMATION

REFERENCES

INTERVIEW TIMES