Send completed application to
COLLEGE BOUND
College Bound
Attn: AmeriCorps & Volunteer Program Manager
110 North Jefferson
St. Louis, MO 63103
Phone: 314-361-4441 ext.109
Fax: 314-436-9210
Email: [email protected]
AmeriCorps Application
August 2016
Applicant Information
Last Name
First Name
Street Address
City
Home Phone Number
M.I.
State
Cell Phone Number
Social Security Number
Zip
Email
Hometown
What position do you prefer?
-FULL-TIME STATE AMERICORPS POSITIONS-
-VISTA SUMMER ASSOCIATES-
College Preparation Coach
Enrollment VSA
Humanities VSA
College Completion Coach
Development VSA
STEM VSA
Volunteer VSA
*While College Bound will note position preference; we reserve the right to offer each individual the opportunity best suited for him or her.
Are you a United States citizen, national, or lawful permanent resident alien?
If you are a lawful permanent resident alien, what is
your registration number and card expiration date?
Yes
Have you received your high school diploma or GED?
Yes
No
Have you ever used any other name?
Yes
No Name(s) used:
Have you ever been discharged from any position?
Have you ever been convicted of a crime or violation other than a minor traffic violation?
If yes, list all convictions, starting date, nature of offenses and where they occurred:
Other Information
How did you hear about these positions? Please check all that apply.
Career Center
Job Fair
Tabling
Professor/Instructor
School List-Serve
Flyer
Postcard
Class Presentation
Idealist.org
AmeriCorps.gov
Craigslist
Newspaper (please list):
College Bound Staff member or Board member
Other website:
Other:
Name:
No
Supporter or Friend of College Bound
Name:
Optional Information
Providing the following information is optional.
Ethnicity:
How would you identify your family’s economic background?
Are or were you a first generation college student?
Yes
No
Applicant Education
Name of College or
University
City and
State
Dates
Attended
Major/Minor/
Course of Study
Type of Degree
or Certificate
Date
Received or
Expected
Military Experience
Were you in U.S. Armed Forces?
Dates of service:
Yes
No If yes, which service?
Rank at separation:
Duties:
Personal Statements
Please answer the following questions. Feel free to continue beyond the indicated lines, but
please limit your responses to no more than 300 words.
1. Why do you want to serve with College Bound?
2. How have you been involved or served in your community? (Please include what you could
contribute during your year of service as an AmeriCorps member, and what you hope to gain
from the experience.)
3. What kind of experiences have you had that you think have helped prepare you for working
with diverse populations, including youth from low-income backgrounds?
4. If you have a favorite quote that inspires you, please share it with us.
5. Please use the space below for any additional information which you believe will assist in
arriving at a true estimation of your qualifications.
References
Professional references only. No friends or family please.
#1 Salutation & Reference Name
Street Address
Reference email
City
Phone number
#2 Salutation & Reference Name
Street Address
Reference email
City
Street Address
Reference email
State
Zip
State
Zip
Relationship
City
Phone number
Zip
Relationship
Phone number
#3 Salutation & Reference Name
State
Relationship
Certification
By signing below, I certify that all of the statements made in this application are true, correct,
and complete, to the best of my knowledge, and are made in good faith. I understand that
misinformation or omission of information could result in disqualification and/or termination as an
AmeriCorps member. I also understand that my selection as an AmeriCorps member will require
a National Criminal Background Check. I also indicate that I am prepared to serve a 12-month
full-time term of service with College Bound from August 2015 to August 2016.
Signature (or typed name)
Date
Send completed application to
College Bound, Attn: AmeriCorps Coordinator, 110 North Jefferson, St. Louis, MO 63103
Email: [email protected]
Phone: 314-361-4441 ext. 109
Fax: 314-436-9210
 College Bound application
Materials needed to complete application:
 Cover Letter  College transcript
 Resume
 My.AmeriCorps.gov profile