Member Enrollment Request

SITE STAFF: Complete the following information to notify Red River Community Corps of your intent to select an individual for your agency's AmeriCorps slot. A member enrolled in AmeriCorps is contingent on meeting AmeriCorps eligibility requirements, completing all required paperwork, and passing the National Service Criminal History Check.

This form is for awarded slots with agencies holding an approved, AmeriCorps site application through Red River Community Corps', Oklahoma Opportunities program. Sites must also have an approved position description before a member can be enrolled. Complete this form once your agency identifies the candidate suitable for your open position. All fields marked with an asterisk are required.

Red River Community Corps' program staff uses the information provided in this form to determine AmeriCorps State service eligibility. The candidate must complete all required enrollment paperwork and be eligible to start service at least 1 business day prior to the anticipated start date.

Please allow two weeks to process AmeriCorps eligibility and AmeriCorps enrollment.

Host Site: *

Site Supervisor First & Last Name: * 🛈

Site Supervisor Email: *

Site Supervisor Phone Number: *

AmeriCorps Candidate First & Last Name: * 🛈

AmeriCorps Candidate Personal Email (must be able to access for 7 years): * 🛈

AmeriCorps Candidate Cell Phone Number: *

Please provide the phone number best suited to reach your member during service hours: *

Has this candidate served with the Oklahoma Opportunities, AmeriCorps State program before? * 🛈

Yes

No

I'm not sure

AmeriCorps Position Title (position description title given by your agency, aligning host site application): *

Please select the Candidate's intended term type: * 🛈

Full-Time members must total 40 hours per week.

Three Quarter-Time members must total 40 hours per week.

Half-Time members must total 25 hours per week.

Quarter-Time members must total 25 hours per week.

Minimum-Time members must total 40 hours per week.

Monday

Will the member be expected to serve on Mondays? *

Starting Time *

Ending Time *

Anticipated hours served on Mondays. *

Tuesday

Will the member be expected to serve on Tuesdays? *

Starting Time *

Ending Time *

Anticipated hours served on Tuesdays. *

Wednesday

Will the member be expected to serve on Wednesdays? *

Starting Time *

Ending Time *

Anticipated hours served on Wednesdays. *

Thursday

Will the member be expected to serve on Thursdays? *

Starting Time *

Ending Time *

Anticipated hours served on Thursdays. *

Friday

Will the member be expected to serve on Fridays? *

Starting Time *

Ending Time *

Anticipated hours served on Fridays. *

Saturday

Will the member be expected to serve on Saturdays? *

Starting Time *

Ending Time *

Anticipated hours served on Saturdays. *

Sunday

Will the member be expected to serve on Sundays? *

Starting Time *

Ending Time *

Anticipated hours served on Sundays. *

Total Weekly Hours

0.00

Will your AmeriCorps member be serving a roughly consistent schedule through August 31, 2025? *

Describe circumstance(s) that prevent a consistent schedule to be maintained through August 31, 2025. Example: 1.) Your host site is a school or after school program with fall/winter/spring breaks and ending service in May. 2.) Your host site programs are offered with an at-hawk schedule and members fill a schedule as-needed in some instances. Etc. *

If this member will be providing more than 50% of their service activities at an alternative location, different than your agency's primary address, please list the physical address where your AmeriCorps member will be providing their service activities.

Name of Institution, Non-Profit, State Agency, etc,:

Street Address

Address Line 2

City

Zip Code

Phone number to alternative service location: