Member Enrollment Request

SITE STAFF: Complete the following information to notify Red River Community Corps of your intent to select an individual for an awarded 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. Complete this form immediately after identifying your organization's AmeriCorps candidate choice. 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. See start dates.

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: *

Phone number to physical service location (or number to reach member during service): *

Is this candidate a returning AmeriCorps member? * 🛈

Yes

No

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

AmeriCorps Position Title (given by your organization): *

If the member will not be placed at the physical address of your Host Site Organization, please provide the physical address of where your AmeriCorps member will be doing the majority of service activities.

Name of Institution, Business, Public Affiliation, etc,:

Street Address

Address Line 2

City

Zip Code

Phone number to alternative service location: