Resilient Alaska Youth AmeriCorps Member Application
This is an application for the Resilient Alaska Youth AmeriCorps Program. Make sure to gather contact information for your desired host organization including phone number and email address. The Host organization is the local placement site for your position, typically the school, tribal government or city government office. In addition, make sure you have names and contact information for references and former employers.


AmeriCorps  is committed to building a diverse and inclusive workforce. AmeriCorps maintains a zero-tolerance policy for any unlawful discrimination and harassment conduct towards any employee, intern, or contractor. As a federal agency, we take our responsibility to comply with the anti-discrimination laws and the regulations enforced by the U.S. Equal Employment Opportunity Commission seriously and commit to treating all persons with dignity and respect. Our agency prohibits any forms of discrimination and harassment based upon a person’s protected status. “Protected status” means a person’s race, color, national origin, gender, age (40 and over), religion, sexual orientation, disability (mental or physical), gender identity or expression, political affiliation, marital or parental status, pregnancy, reprisal, genetic information (including family medical history), or military service. AmeriCorps seeks to provide a work environment that is free of discrimination and harassment, and to provide all employees the freedom to compete on a fair and level playing field.
Sign in to Google to save your progress. Learn more
Email *
First Name *
Middle Name (or N/A if none) *
Last Name *
Will you be at least 18 years old as of 12/01/2021 (members must be at least 18) *
Mailing Address (or PO Box Number) *
City *
Zip Code *
Cell Phone Number (or N/A) *
Landline Phone (or N/A) must enter cell or landline *
Host Organization Name (School, Tribal Gov't, City Gov't) where you will serve *
Best Contact Person at the Host Organization to Discuss Placement: Name, title *
Phone Number of Host Organization *
Email Address of Host Organization
Educational Information (check all that apply) *
Required
What is your primary language? *
List any other languages you are fluent in?
Prior National Service Experience? Please check all that apply *
Required
If you have had prior national service experience, please provide details of your service, including Name of Program or Branch of Service, Dates of Service, and, if you were a Member of the Armed Services, Type of Discharge.
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms