2021-2022 AmeriCorps Utah Disaster Corps

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Please complete all required fields below:

Full Name *

Email *

Phone number *

What AmeriCorps program are you serving with? *

When will you complete your current term of service? *

Which year of service are you currently in with AmeriCorps? *

Year 1

Year 2

Year 3

Year 4

Other:

In order to qualify you must currently have at least a six months remaining in your term. Do you meet this requirement? *

Yes

Required

Have you received approval from your program to participate as a Disaster Corps member? *

Yes

In order to fully participate you will need to have at least 20 hours of member development available during your term. Do you meet this requirement? *

Yes

Why are you interested in joining the AmeriCorps Utah Disaster Corps?

Are you willing to accept a temporary reassignment of duties in the event of a state or federally declared disaster within Utah? *

Yes

Please type your full legal name indicating that you understand and agree to the following: 1- The answers provided in this form are accurate to the best of your knowledge. 2- Participation in the AmeriCorps Utah Disaster Corps is for member development purposes. 3- Participation does not provide any additional monetary compensation. 4- Failure to provide accurate information may be grounds for disqualification from the Disaster Corps. *

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