FY23 AmeriCorps Individual Match Waiver Request Form
For single-state Kentucky applicants.

This is a revised process for AmeriCorps State and National (ASN) Direct Applicants and Grantees to request an individual match waiver. The intent of this process is simply to have your organization identify and document the specific circumstances your organization faced or is facing in meeting its match requirement at any point in your organization’s grant.

AmeriCorps State subgrantees should submit their waiver requests to their State Service Commission (Serve Kentucky) for review and approval. If the Commission approves the subgrantee(s) waiver request for submission, the Commission will submit the request(s) on behalf of the subgrantee(s).

Per 45 CFR §2521.70, all four criteria below must be met for ASN grants. While the agency has included some examples of sufficient justifications for each of them, individual grantees' circumstances vary and all justifications will be seriously considered.

AmeriCorps' Office of Grant Administration (OGA) will review and evaluate all justifications provided on this form for sufficiency with the respective regulatory provisions using a prudent person standard. OGA will respond within 30 calendar days of receiving the initial request with a decision or request for additional information. 

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Email *
Authorized Representative Name *
Authorized Representative Phone Number *
Organization Name *

1. The lack of resources at the local level. 

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To meet this criterion, please provide a bulleted list of items such as: reduced state or local budget for allowable sources of cash or in-kind match, reduced corporate and/or foundation giving, any other applicable examples of the lack of local resources (such as deep poverty or other economic circumstances).
2. That the lack of resources in your local community is unique or unusual.
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To meet this criterion, please provide at least one example such as: a comparison to another nearby community with more resources, a comparison to another point in time for the community(s) served, etc.

3. The efforts you have made to raise matching resources.
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To meet this criterion, please provide a bulleted list of prospective funders who denied requests for funding this year and the amounts of the requests to each funder.
4. The amount of matching resources you have raised or reasonably expect to raise.
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To meet this criterion, please provide a bulleted list of secured or likely funders and the amount you expect to receive from each one.
Requested dollar amount and percentage of match to be waived.
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Bulleted list of proposed activities on the Grantee Share of the budget that would not happen if the waiver is granted. 

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Program year or years for which you are requesting a match waiver.
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