Life After Americorps Activities

Member-Initiated Hours Request Form

Member Name: / Click here to enter text. / Supervisor Name: / Click here to enter text.
Host Site: / Click here to enter text. / Alliance Trainer: / Click here to enter text.

Fill out this form electronically then print and HAND-SIGN; scan a completed copy to your Alliance trainer via email.

SErviceActivities

Name of Activity:Click here to enter text. / Organization Name:
Click here to enter text.
Contact Person Name: Click here to enter text.
Email: Click here to enter text.
Phone: Click here to enter text. / Description of Service Activity:
Click here to enter text. / Anticipated Number of Hours:
Click here to enter number
Select Type of Activity:
☐On-Going ☐One Time / How will this service activity benefit your community and add to your term of service?
Click here to enter text.
Start Date:
Click here to enter a date. / End Date:
Click here to enter a date.
Name of Activity:Click here to enter text. / Organization Name:
Click here to enter text.
Contact Person Name: Click here to enter text.
Email: Click here to enter text.
Phone: Click here to enter text. / Description of Service Activity:
Click here to enter text. / Anticipated Number of Hours:
Click here to enter number
Select Type of Activity:
☐On-Going ☐One Time / How will this service activity benefit your community and add to your term of service?
Click here to enter text.
Start Date:
Click here to enter a date. / End Date:
Click here to enter a date.
Name of Activity:Click here to enter text. / Organization Name:
Click here to enter text.
Contact Person Name: Click here to enter text.
Email: Click here to enter text.
Phone: Click here to enter text. / Description of Service Activity:
Click here to enter text. / Anticipated Number of Hours:
Click here to enter number
Select Type of Activity:
☐On-Going ☐One Time / How will this service activity benefit your community and add to your term of service?
Click here to enter text.
Start Date:
Click here to enter a date. / End Date:
Click here to enter a date.
Total Service Hours: Click here to enter number

Training Activities

Name of Activity:Click here to enter text. / Training source:
(list organization/conferencename;website and link; book title and author; or webinar title and organization name)
Click here to enter text. / Description of Training Activity:
Click here to enter text. / Anticipated Number of Hours:
Click here to enter number
Select Type of Activity:
☐On-Going ☐One Time / How will this training activity relate to and benefit your service?
Click here to enter text.
Start Date:
Click here to enter a date. / End Date:
Click here to enter a date.
Name of Activity:Click here to enter text. / Training source:
(list organization/conference name;website and link; book title and author; or webinar title and organization name)
Click here to enter text. / Description of Training Activity:
Click here to enter text. / Anticipated Number of Hours:
Click here to enter number
Select Type of Activity:
☐On-Going ☐One Time / How will this training activity relate to and benefit your service?
Click here to enter text.
Start Date:
Click here to enter a date. / End Date:
Click here to enter a date.
Name of Activity:Click here to enter text. / Training source:
(list organization/conference name;website and link; book title and author; or webinar title and organization name)
Click here to enter text. / Description of Training Activity:
Click here to enter text. / Anticipated Number of Hours:
Click here to enter number
Select Type of Activity:
☐On-Going ☐One Time / How will this training activity relate to and benefit your service?
Click here to enter text.
Start Date:
Click here to enter a date. / End Date:
Click here to enter a date.
Name of Activity:Click here to enter text. / Training source:
(list organization/conference name;website and link; book title and author; or webinar title and organization name)
Click here to enter text. / Description of Training Activity:
Click here to enter text. / Anticipated Number of Hours:
Click here to enter number
Select Type of Activity:
☐On-Going ☐One Time / How will this training activity relate to and benefit your service?
Click here to enter text.
Start Date:
Click here to enter a date. / End Date:
Click here to enter a date.
Total Training Hours: Click here to enter number.

Life After AmeriCorps Activities

Name of Activity:Click here to enter text. / Select Life After AmeriCorps Activity: (must be onbelow list)
☐Resume/Cover Letter Work
☐Job Search/Interview
☐Informational Interview
☐Professional Networking
☐Standardized Test Prep
☐Scholarship/Financial Aid Application ☐Applying for college/
researchingoptions / Description of life after AmeriCorps Activity:
Click here to enter text. / Anticipated Number of Hours:
Click here to enter number
Select Type of Activity:
☐On-Going ☐One Time
Start Date:
Click here to enter a date. / End Date:
Click here to enter a date. / How will this activity advance your life after AmeriCorps plans?
Click here to enter text.
Name of Activity:Click here to enter text. / Select Life After AmeriCorps Activity: (must be onbelow list)
☐Resume/Cover Letter Work
☐Job Search/Interview
☐Informational Interview
☐Professional Networking
☐Standardized Test Prep
☐Scholarship/Financial Aid Application ☐Applying for college/
researching options / Description of life after AmeriCorps Activity:
Click here to enter text. / Anticipated Number of Hours:
Click here to enter number
Select Type of Activity:
☐On-Going ☐One Time
Start Date:
Click here to enter a date. / End Date:
Click here to enter a date. / How will this activity advance your life after AmeriCorps plans?
Click here to enter text.
Total Life After AmeriCorps Hours (Max 20): Click here to enter number.

signatures

Please fill out the form electronically then print and HAND-SIGN this form; scan a completed copy to your Alliance trainer via email. This must be approved and submitted prior to engaging in any member-initiated activates. Supervisor and Member to keep original to reconcile with timesheets when recording activities and verifying hours.

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Member SignatureDateSupervisor SignatureDate