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					SERVE Northern New England

Students Engaged in Redefining a Vision for Education in Northern New England
Member Application
Please be sure that you fully complete the application and attach all supporting documents.

Application Checklist
    
Personal Statement Service Project Plan Attach Copy of your Proof of Eligibility (See Section V) Attach Government-Issued Photo ID for Criminal Background Check New Hampshire Members: Complete the state criminal background check form, found at www.vtcampuscompact.org. Be sure to have it notarized, and include and include it with this application. Vermont and Maine have no form.  Signatures  Member Signs AmeriCorps Enrollment Form (Page 7)  Member and Site Supervisor completes Application Signature Page (Page 11)  Member and Site Supervisor signs Service Agreement (Page 18). Be sure that you carefully read the Service Agreement before signing.  Complete the Orientation with your Site Supervisor. Member Orientation is required prior to service.

SERVE Northern New England
Member Application
I. Term of Service and Start Date. Please choose and Term of Service and a Start Date. Please note that the Start Date must be after you have completed this application and have attended a Member Orientation. Part Time= Part Time= Reduced Half Time = Quarter Time = Minimum Time = 900 hours/2 years 900 hours/1 year 675 hours/ 1 year 450 hours/ 1 year 300 hours/ 1 year $2,362 Education Award $2,362 Education Award $1,800 Education Award $1,250 Education Award $1,000 Education Award

Service Start Date (mm/dd/yy)
II. Applicant Information- ALL information required.

NAME (FIRST, MIDDLE, LAST): SOCIAL SECURITY NUMBER: INSTITUTION: TELEPHONE NUMBER: CURRENT MAILING ADDRESS: CITY: PERMANENT ADDRESS CITY: STATE: ZIP:
YES NO

DATE OF BIRTH:

EMAIL:

STATE:

ZIP:

ARE YOU A U.S. CITIZEN OR PERMANENT RESIDENT ALIEN? SITE SUPERVISOR NAME:

SERVE Northern New England
III. Personal Statement Please address the following questions in one to two pages:  Why do you want to join AmeriCorps?  What skills do you possess that make you any exceptional candidate for this position?  What personal experiences have you had that can help you contribute to the project? Please tell us about community service, volunteer management, service-learning, and/or educational experiences that will help you succeed at this project.

IV. Service Project Plan Please describe the work you will be doing and the issues that you will be addressing.

SERVE Northern New England

Community Outcomes In a few sentences, please describe the community need that you hope to address with your project.

In a few sentences, please describe the expected outcomes/results of you project.

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In a few sentences, please describe how your service will impact the communities in which you will serve.

Please list all community organization(s) with which you plan to serve and the person(s) that will supervise your service at the organization(s)
Organization 1 Supervisor/contact Address Phone City Email State ZIP

Organization 2 Supervisor/contact Address Phone City Email State ZIP

Organization 3 Supervisor/contact Address Phone City Email State ZIP

SERVE Northern New England
V. Member Eligibility Verification Form

See August 22, 2003 Memorandum Re: Grants Management Guidance 02-02, Documentation of Member Eligibility and Member Record Retention for additional guidance
Regarding proof of member citizenship or lawful permanent resident status, programs must ascertain and document the citizenship status of the members, a record of which must be kept in the member’s file. Listed below are examples of types of documents programs should request in addition to self-certification. Any one of the below documents is adequate verification of eligibility.

Proof of Eligibility
Birth Certificate from one of the 50 states, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa, or the Northern Mariana Islands Valid U.S. Passport issued to the individual as a U.S. citizen U.S. Dept. of State Form FS-240, Report of Birth Abroad of a Citizen of the United States U.S. Dept. of State Form FS-545, Certificate of Birth-Foreign Service U.S. Dept. of State Form DS-1350, Certificate of Report of Birth INS certificate of naturalization (INS Form N-550 or N-570) INS certificate of citizenship (INS Form N-560 or N-561) Permanent Resident Card (INS Form I-551) Alien Registration Receipt Card (INS Form I-551) A passport indicating that the INS has approved it as a temporary evidence of lawful admission for permanent residence A Departure Record (INS Form I-94) indicating that the INS has approved it as a temporary evidence of lawful admission for permanent residence Other – If one of the above primary documentation is not available, the program must obtain written approval from the Corporation for National and Community Service that other documentation is sufficient to demonstrate the individual’s status as a U.S. citizen, U.S. national, or lawful permanent resident

To be completed by Site Supervisor Please make a copy of one of these documents and attach to the completed application. Members are required to provide proof of eligibility before beginning service.

AMERICORPS ENROLLMENT FORM
Completion of this form is required to enroll an AmeriCorps member in the National Service Trust, making the member eligible for an education award upon successful completion of his or her term of service. It also provides the Corporation for National and Community Service with basic demographic data.

DIRECTIONS TO MEMBER:
1. Use blue or black ink. 2. Print clearly. 3. Please complete and sign Part 1 and Part 2. 4. Return the completed form.

PART 1
Last

Member: Please Complete and Sign
____________________________
First

1. Name _____________________________

_____
MI

2. Date of Birth ______ ____ ________ 3. Social Security Number _____________________________ 4. Citizenship Status  U.S. Citizen U. S. National  Lawful Permanent Resident Alien of the United States 5. High School Status:
Month Day Year

I have received a high school diploma or its equivalent. I agree to obtain a high school diploma or its equivalent before using my education award,
and I did not drop out of elementary or secondary school to enroll in the program. or

6. Males 18-26 years old not yet registered with the Selective Service System: If you would like the Corporation for National
and Community Service to provide the information on this page to the Selective Service System so that theagency may register you, please check this box. 

7. Current Address (All information will be sent to you at this address until you notify the Corporation of a change of address.) ________________________________________________________________________________________
Number and Street

___________________________________ ______ _________ ________
City E-Mail Address State Zip Code

____________________________________________________________________ __________________ ________ ___________________ _______
Home Phone Business Phone 8. Permanent Address (Name and address of person through whom you can always be reached once you leave the program.)

_____________________________
Last

____________________________
First

_____
MI

__________________________________________________________________________________________
Number and Street

___________________________________ ______
City

_________
State

________
Zip Code

____________________________________________________________________
E-Mail Address

__________________________
Home Phone

__________________ _______
Business Phone

Member's Signature _________________________________________________________ Date: _________________
I understand that a knowing and willful false statement on this form can be punished by a fine or imprisonment or both under Section 1001 of Title 18, U.S.C.

PART 2

Member: Please Answer the Following Questions

Public reporting burden -- Estimated time to complete this form, including time for reviewing instructions and gathering and providing the information needed to complete the form, is 3 minutes for the Member section and 4 minutes for the Certifying Official section. Send comments regarding this burden or the content of this form to: Corporation for National and Community Service, National Service Trust, 1201 New York Avenue, NW, Washington, DC 20525. The Corporation informs the potential persons who are to respond to this collection of information that such persons are not required to respond to the collection of information unless it displays a currently valid OMB control number on this page of the form (see 5CFR 1320.5(b)(2)(1)). OMB Approval No.: 3045-0006 Expires 04/30/200

1. What is your gender?

O Female O Male
2. Are you registered to vote?

7. Are you a veteran of the United States Armed Forces? O Yes O No 8. What are the two most important reasons why you decided to join this program? O To get an education award O To help other people/perform a community service O To be part of a national movement O To get a job/earn money O Friends have joined O To make friends O To learn about or work with different ethnic/cultural groups O Parents/teachers wanted me to join O To explore future job/education interests O To get involved in health issues O To get involved in education issues O To get involved in environment issues O To get involved in public safety issues O Other (Specify: ____________________________) 9. How did you hear about this program? (Mark all that apply.) O Read about it in an article O Saw an advertisement in a newspaper/magazine O Guidance counselor/teacher O Parent/relative O Current or former AmeriCorps Member O Friend told me/friend applied O Heard about it on TV commercial O Heard about it on radio commercial O Heard about it on the internet O Heard about it from an AmeriCorps recruiter/ representative O Received information in the mail O AmeriCorps Program O Poster O Other (Specify: ____________________) 10. Have you ever previously enrolled in an AmeriCorps program? O Yes O No If so, how many times: _____
11. Have you ever been released 'for cause' from a term of service by this or any other AmeriCorps program?

O Yes O No O Not sure O Not eligible O Prefer not to respond
3. (Optional) Which of the following categories best describes your racial or ethnic origins? (Mark one or more from A and one from B) A. Race

O American Indian or Alaska Native O Native Hawaiian or Other Pacific Islander O Black or African American O White O Asian O Other B. Ethnicity O Hispanic origin O Not of Hispanic origin
4. Which one of the following best describes your marital status?

O Single, never married O Married, living with husband/wife O Married, not living with spouse/legally separated O Widowed O Divorced O Prefer not to respond
5. What is the highest level of education you have completed?

O Less than high school completed O GED O High school graduate O Technical school/apprenticeship/vocational O Some college O Associates degree (AA) O College graduate O Some graduate school O Graduate degree O Professional degree (medical, law)
6. Do you have a disability?

O Yes (Specify: _______________________________) O No O Prefer not to respond

O Yes O No

SERVE Northern New England
AmeriCorps Education Award Orientation Checklist

Member Name Campus

After finishing the Orientation power point, please review and initial the orientation checklist. Your site supervisor can answer questions about the information below.

I have reviewed the SERVE Northern New England Orientation and understand the following conditions: Number of hours needed to complete my term of service and the timeframe to finish my hours Prohibited and allowable activities for my AmeriCorps hours. That this will be one of the two AmeriCorps Education Awards that I can receive in my lifetime. How and where I can use my AmeriCorps Education Award. That I will not be able to receive a partial award (except for personal and compelling circumstances) The difference between service and training and fundraising hours and the maximum number of training and fundraising hours. How to report hours on monthly Records of Service The drug and alcohol policy

Application Signatures
Site Supervisor Verification of Proof of Eligibility
I certify that I have seen the original proof of eligibility, a copy of which is attached to this application. Site Supervisor Signature Date

Verification of Member Orientation
I certify that I have received the Member Orientation, and understand the terms of service, including allowable and prohibited activities, and the paperwork required to receive an education award. Member Signature Date

I certify that the member has received an orientation and I have discussed paperwork requirements with him/her. Site Supervisor Signature Date

Criminal Background Check Authorization
By signing below, I acknowledge that Vermont Campus Compact will perform a check of the National Sex Offender Registry (NSOR) and a criminal history check of the registries of both the state where I will serve and the state where I currently live, and consider the results before I may begin my service. I understand that a positive finding on the NSOR will prevent my service with SERVE Northern New England. I also understand that a condition of service for all members is consent to both of these background checks.
New Hampshire Members: Remember to complete separate state forms, including the signature of a Notary Public.

Member Signature

Date

I certify I have seen the member’s original government-issued photo ID, a copy of which is included with this application (note, if a passport was used for the Proof of Eligibility, another ID is not necessary). Site Supervisor Signature Date

SERVE Northern New England
Campus Compacts of Maine, New Hampshire, and Vermont Northern New England Service Agreement

Applicant Name Institution Term of Service (Select one) Part Time (900 hours/2 years) Reduced Half Time (675 hours/ 1 year) Minimum Time (300 hours/ 1 year) Service Start Date (mm/dd/yy) Part Time (900 hours/1 year) Quarter Time (450 hours/ 1 year)

I.

Purpose

It is the purpose of this agreement to delineate the terms, conditions, and rules of participation of in SERVE Northern New England (SERVE NNE) under coordination of Vermont Campus Compact. Hereinafter, the applicant will be known as “Member”, the college/university known as “Host Site”, and SERVE NNE known as “Program”. II. Minimum Qualifications

The Member certifies that he/she is a United States citizen, a United States national, or a lawful permanent resident alien and at least 17 years of age. By signing this contract the Member will also certify, under penalty of law that she/he has a high school diploma or equivalency certificate or agrees to obtain one before using the Education Award. III. Terms of Service

(a) The Member’s Term of Service begins on the date specified above and lasts for the time specified above . (b) The Member will complete the minimum number of hours specified by the Term of Service selected above during the period specified above. Of these hours, a maximum of 20% may be training, education, or other similar approved activities, and 10% may be allowable fund-raising activities. (c) The Member understands that he/she may suspend his/her Term of Service due to compelling personal circumstances as described in Section X, Paragraph (c) of this agreement. This request must be submitted in writing before the member wishes to suspend the term. A term may be suspended up to one year pending approval by Vermont Campus Compact. If a suspension is granted the member must have all Records of Service, up to the date of suspension, submitted before the suspension can take effect. (d) The Member may change their Term of Service as long as there are additional spaces available by completing a Change of Service form and submitting it to Vermont Campus Compact within three (3) months of the Member’s enrollment date. The Change of Service form must be signed by the Member and Site Supervisor (e) The Member understands that in order to successfully complete the Term of Service (as defined by Vermont Campus Compact and consistent with regulations of the Corporation for National Service) and to be eligible for the Education Award s/he must complete portion (b) above and complete all required Records of Service, to be sent to Vermont Campus Compact 15 days after the end of the month and two member reports to be sent to VCC after the first 5 months of service and with the Member’s exit paperwork.

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(f) The Member understands that in addition to service hours, s/he must complete two (2) member reports and complete three (3) training events. The Member understands that orientation counts as one training and that he/she is responsible for finding appropriate trainings to attend and documenting those hours on his/her training log. (g) The Member understands that in order to be eligible for serving a second Term of Service, the Member must receive satisfactory performance evaluations focusing on factors such as whether the Member has: 1) 2) 3) completed the required number of hours; completed assignments, tasks or projects in a satisfactory manner; met any other criteria that were clearly communicated both orally and in writing at the beginning of the Term of Service.

(h) The Member understands, however, that eligibility for an additional Term of Service does not guarantee selection or placement. (i) The Member understands that he/she is eligible for only two (2) Education Awards in their lifetime regardless of voucher amount. The only exception to this rule is the AmeriCorps*VISTA program. A person may participate as a third-term AmeriCorps*VISTA with the understanding that you will be receiving a cash stipend instead of the Education Award. The Member may also participate in a third term of any AmeriCorps program without being eligible to receive an Education Award. (j) The Member understands that it is his/her responsibility to turn in paperwork in a timely manner. The monthly Record of Service is due to the Site Supervisor within the first ten (10) days of the following month. The Member also understands that if a Record of Service is not received within three (3) months, the month will receive zero (0) total service hours. (k) The Member understands that it is his/her responsibility to complete and mail exit paperwork directly to Vermont Campus Compact within five (5) days of completing his/her Term of Service. (l) The Member understands that thirty (30) days after the scheduled completion date he/she may be exited without an Education Award with no fault to Vermont Campus Compact. IV. Benefits

(a) Upon successful completion of the Member’s full Term of Service, the Member will receive an Education Award from the National Service Trust. Prior to using the Education Award, the Member agrees (in the event the Member has not yet received a high school diploma or its equivalent, including an alternative diploma or certificate for individuals with learning disabilities) to obtain a high school diploma or its equivalent (unless the Member is enrolled in an institution of higher education on an ability to benefit basis). The Member understands that his/her failure to disclose to Vermont Campus Compact any history of having been released for cause from another AmeriCorps Program will render the Member ineligible to receive the Education Award. (b) Upon enrollment and acceptance into SERVE Northern New England, the Member is eligible for forbearance of any qualified student loan. (c) If the Member has received forbearance on a qualified student loan during the Term of Service, and the Member successfully completes the Term of Service, the National Service Trust will repay a pro-rated portion of any interest that accrued on the loan during the time of service. V. Rules of Conduct

(a) The Member is expected to, at all times while acting in an official capacity as an AmeriCorps Member: 1) 2) 3) 4) demonstrate mutual respect toward others; follow directions and complete all assigned tasks in a professional manner; direct concerns, problems and suggestions to your Site Supervisor or Vermont Campus Compact; adhere to the rules of conduct applicable to the professional staff at the host site.

(b) At no time may the Member: 1) 2) engage in any activity that is illegal under local, state or federal law; engage in activities that pose a significant safety risk to others.

SERVE Northern New England
3) 4) 5) 6) 7) engage in partisan or nonpartisan election activities, in voter registration activities, providing transportation to the polls, and in any activity intended to influence the passage or defeat of legislation or proposals by initiative petition; engage in activities or duties that assist, directly or indirectly, any labor or anti-labor organizing activity, or related activity; engage in planning, initiating, participating in, or otherwise aiding or assisting in any demonstration, give religious instruction, conduct worship services, or engage in any other religious activity as part of their duties; be compensated for services.

(c) The Member understands that the following acts also constitute a violation of the Program’s rule of conduct: 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) unauthorized tardiness; unauthorized absences; repeated use of inappropriate language (i.e. profanity) at job site; failure to wear appropriate clothing to service assignments; stealing or lying; engaging in activity that may physically or emotionally damage other Members of the Program or of the community; possessing or using any illegal drugs during the Term of Service; consuming alcoholic beverages during the performance of service activities; being under the influence of alcohol or any illegal drugs during the performance of service activities; failure to notify Vermont Campus Compact of any criminal arrest or conviction occurring prior to or during service.

(d) For violating the above stated rules, Vermont Campus Compact will work with the Host Site to take appropriate action up to and including release from the AmeriCorps Program and loss of all benefits as described in section III. (e) Vermont Campus Compact reserves the right to release the Member for cause if, in the opinion of the Program Director, her/his conduct undermines the effectiveness of the Program or the project to which s/he is assigned. VI. Drug and Alcohol Policy (a) The Drug and Alcohol policy of the Host Site is in effect for SERVE Northern New England. (b) Drug-related Offenses on Host Site property: Pursuant to the Drug-Free Workplace Act of 1988, employees are prohibited from unlawfully manufacturing, distributing, dispensing, possessing or using a controlled substance in the workplace. As further required under the Drug-Free Workplace Act, an employee, as a condition of employment with the SERVE Northern New England, must notify Vermont Campus Compact if she or he is convicted of any criminal drug statute violation occurring in the workplace no later than five days after the conviction. (c) Alcoholic Beverages on Host Site property: Consumption of alcoholic beverages on Host Site property must adhere to the rules and regulations set forth in the Drug and Alcohol Abuse Policy of the Host Site. (d) Drug and Alcohol Use off Host Site property: Unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance, and excessive use of alcohol that may adversely affect a Member's work performance, or that may reflect unfavorably upon public or governmental confidence in the manner in which the Host Site and/or the state Campus Compacts carries out its activities, is prohibited. (e)Drug and Alcohol use is strictly prohibited at any time during which a SERVE Northern New England Member is engaged in any service, outreach, training, or development activity related to or associated with his or her AmeriCorps Membership. (f) Member Assistance: Assistance in dealing with drug and alcohol abuse is available through the Host Site and/or the state Campus Compacts. (g) Disciplinary Action: Failure to adhere to this policy may result in disciplinary action, including termination.

SERVE Northern New England
VII. Pledge The AmeriCorps Member is expected to take the following the pledge: I will get things done for America - to make our people safer, smarter and healthier. I will bring Americans together to strengthen our communities. Faced with apathy, I will take action. Faced with conflict, I will seek common ground. Faced with adversity, I will persevere. I will carry this commitment with me this year and beyond. I am an AmeriCorps Member and I will get things done. VIII. Minor Disciplinary Actions (a) The Host Site may temporarily suspend or impose a fine on a Member for minor disciplinary reasons, such as chronic tardiness, as outlined in the conditions of the Member contract. (b) Vermont Campus Compact may release the Member for cause if, in the opinion of the Program Director, s/he repeatedly or periodically continues to demonstrate inappropriate behavior by engaging in a pattern of misconduct. (c) The Member understands that s/he will be released for cause in accordance with paragraphs (b), (d), and (e) of section VI of this agreement (for committing certain acts during the Term of Service such as being convicted or charged with a violent felony, possession, sale, or distribution of a controlled substance). (d) For violating the above stated rules, the Program will do the following (except in cases where during the Term of Service the Member has been charged with or convicted of a violent felony, possession, sale or distribution of a controlled substance). 1) for the Member’s first offense, an appropriate Program official will issue a verbal warning to the Member; 2) for the Member’s second offense, an appropriate Program official will issue a written warning and reprimand to the Member; 3) for the Member’s third offense, the Member may be suspended for one day or more without compensation; 4) for the fourth offense, the Program may release the Member for cause. IX. Temporary Suspension of Service

The period of suspension does not count toward a Member’s required service hours. X. Release from Terms of Service

(a) The Member understands that s/he may be released for the following two reasons: 1) 2) for cause, as explained in paragraph (b) of this section; or compelling personal circumstances as defined in paragraph (c) of this section.

(b) Vermont Campus Compact will release the Member for cause for any of the following reasons: 1) 2) 3) 4) 5) the Member has dropped out of the Program without obtaining a release for compelling personal circumstances from Vermont Campus Compact; during the Term of Service the Member has been convicted of a violent felony or the sale or distribution of a controlled substance; the Member has committed a fourth offense in accordance with paragraph (d) of section VIII of this agreement; the Member violates any rules of the Host Site which constitute cause dismissal; or any other serious breach that in the judgment of Vermont Campus Compact would undermine the effectiveness of the Program.

(c) Vermont Campus Compact may release the Member from the Term of Service, due to compelling personal circumstances if: 1) 2) 3) the Member has a serious injury or illness that makes completing the term impossible; there is a serious injury, illness or death of an immediate family member and the Member is needed to care for that family member or take over the duties of the family Member; the Member is drafted by the Armed Services of the United States;

SERVE Northern New England
4) 5) termination of the project site and reassignment to another project is not possible. other circumstances occur that make it impossible or very difficult for the Member to complete the Term of Service and the Program deems those circumstances to be compelling.

(d) Vermont Campus Compact will suspend the Member’s Term of Service for the following reasons: 1) 2) 3) during the Term of Service the Member has been charged with a violent felony or crime by the state or distribution of a controlled substance. (If the Member is found not guilty or the charge is dismissed, the Member may resume her/his Term of Service. The Member, however, will not receive credit for any service hours missed.) during the Term of Service the Member has been convicted of a first offense of possession of a controlled substance. (If the Member, however, demonstrates that s/he has enrolled in an approved drug rehabilitation program, the Member may resume her/his Term of Service. The Member will not receive credit for any service hours missed.) for compelling personal circumstances, such as illness or death in the family. A member may resume his/her Term of Service once the issue is resolved.

(e) Vermont Campus Compact may suspend the Member’s Term of Service for violating the rule of conduct provisions in accordance with the rules set forth in section V of this agreement. (f) If the Member discontinues her/his Term of Service for any reason other than a release for compelling personal circumstances as described in paragraph (c) of this section, the Member will cease to receive the benefits described in section IV and will receive no portion of the Education Award or interest payments. (g) If the Member discontinues her/his Term of Service due to compelling personal circumstances as described in paragraph (c) of section X of this agreement, the Member will cease to receive benefits described in section IV. If, however, the Member has completed at least 15% of the required hours, the Member will receive a pro-rated portion of the Education Award and interest payments described in section IV. XI. Grievance Procedure

(a) The Member understands that Vermont Campus Compact has a grievance procedure to resolve disputes concerning the Member’s suspension, dismissal, service evaluation or proposed service assignments. (b) The Member understands that, as a participant in the Program s/he may file a grievance in accordance with the Program’s grievance procedure, which is set forth as follows: In the event that informal efforts to resolve disputes are unsuccessful, individuals may seek resolution through the following grievance procedures. These procedures are intended to apply to service-related issues, such as assignments, evaluations, suspensions, or release for cause, as well as issues related to non-selection of Members, and displacement of employees, or duplication of activities by AmeriCorps Members. (c) Optional Alternative Dispute Resolution (ADR) ADR is available, but must be selected within 45 days of the underlying dispute. If an aggrieved party chooses ADR as a first option, a neutral party designated by Vermont Campus Compact (VCC) will attempt to facilitate a mutually agreeable resolution. The neutral party must not have participated in any previous decisions concerning the issue in dispute. ADR is confidential, non-binding, and informal. No communications or proceedings of ADR may be referred to at the grievance hearing or arbitration stages. The neutral party may not participate in subsequent proceedings. If ADR is chosen by the aggrieved party, the deadlines for convening a hearing and of a hearing decision, 30 and 60 days respectively, are held in abeyance until the conclusion of ADR. At the initial session of ADR, the neutral party must provide written notice to the aggrieved party of his or her right to request a hearing. If ADR does not resolve the matter within 30 calendar days, the neutral party must again notify the aggrieved party of his or her right to request a hearing. At any time, the aggrieved party may decline ADR and proceed directly to the hearing process.

(d) Grievance Hearing

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An aggrieved party may request a grievance hearing without participating in ADR or, if ADR is selected, if it fails to result in a mutually agreeable resolution. The aggrieved party should make a written request for a hearing to Amy McGlashan, Executive Director of Vermont Campus Compact. A request for a hearing must be made within one year after the date of the alleged occurrence. At the time a request for a hearing is made, the Program should make available to the aggrieved party information that it relied upon in its disciplinary action. The Program will arrange for one or more pre-hearing conferences at a time mutually convenient to the parties. Pre-hearing conferences are not a substitute for a hearing. They are intended to facilitate a mutually agreeable resolution of the matter to make a hearing unnecessary or to narrow the issues to be decided at the hearing. The format of the pre-hearing conference may be flexible, involving meetings with one party at a time and/or with both parties together. Pre-hearing conferences will be conducted by Laura Rooney, Vermont Campus Compact AmeriCorps Programs Coordinator. The hearing will be conducted by Amy McGlashan, VCC Executive Director. The person conducting the hearing may not have participated in any previous decisions concerning the issue in dispute. In the event that Amy McGlashan has participated in previous decisions regarding the issue in the dispute, Vermont Campus Compact will appoint another party to conduct the hearing. A hearing must be held no later than 30 days after the filing of the grievance, and a written decision must be made no later than 60 days after filing. (e) Binding Arbitration An aggrieved party may request binding arbitration if a grievance hearing decision is adverse or if no decision is made within 60 days of the filing of the grievance. The arbitrator must be independent and selected by agreement of the parties. If the parties cannot agree on an arbitrator, the Corporation for National and Community Service's Chief Executive Officer will appoint one within 15 calendar days after receiving a request from one of the parties. An arbitration proceeding will be held no later than 45 calendar days after the request for arbitration, or no later than 30 calendar days after the appointment of an arbitrator by the Corporation's CEO. An arbitration decision will be made no later than 30 days after the commencement of the arbitration proceeding. The cost of arbitration will be divided evenly between the parties, unless the aggrieved party prevails, in which case the Program will pay the cost of the proceeding as well as the prevailing attorneys' fees. XII. Criminal History Checks

(a) The Member understands that as a condition of participation in SERVE Northern New England as an AmeriCorps Member, Vermont Campus Compact will conduct a Criminal History Search and consider the result in determining an individual’s ability to participate in the SERVE Northern New England Program. (b) Persons found on the National Public Sex Offender Registry or convicted of a violent crime will not be permitted to serve in the Program. Other offenses may be grounds exclusion from the program or restrictions on type of service. The determination of eligibility will be based upon ensuring the safety of vulnerable populations. (c) The Member may review and challenge the factual accuracy of a result before action is taken to exclude the applicant from the position. XIII. Amendments to This Agreement

This agreement may be changed or revised by written consent of all parties.

SERVE Northern New England
XIV. Informed Consent, Authorization & Certification To facilitate your placement as an AmeriCorps Member, the Program may need to release your name, interests and any training you have received. The Program Director, Campus Coordinator and Site Supervisor will be in a position to facilitate your placement and are designated to give out this information to organizations or agencies. During the end of term you may require a written or verbal recommendation for employment or admission to a College, University or another program. If requested, the Program Director, Campus Coordinator and Site Supervisor will be in a position to write a recommendation or give a verbal recommendation. For recruitment and promotional purposes there may be times when the Program will photograph you at your service site or during a training event, or a news agency will be present to conduct interviews. All member information must be released to Vermont Campus Compact, the Corporation for National Service and the authorized program evaluators. As a policy, all other information will be kept in strictest confidence and will not be given out without your consent. By signing this release, you authorize the Program Director, Campus Coordinator and Site Supervisor to release all pertinent information to those who require it. The Member, Site Supervisor, and Program hereby acknowledge by their signatures that they have read, understood and agree to all terms and conditions of this agreement, including the attached grievance procedure and Drug and Alcohol Policy (if the Member is under the age of 18 years old the Member’s parent or legal guardian must also sign), under penalty of law. By signing this contract, the Member also certifies, under penalty of law, that s/he that s/he is a United States citizen; a national or a legal permanent resident; at least 17 years of age; and has a high school diploma or equivalency certificate or agrees to obtain one before using the Education Award. Before signing the contract, please check and complete the appropriate information in the table below Degree Held High School Diploma High School Equivalency Certificate Expect to Complete High School Diploma or Equivalency Before Using the Education Award Include expected date of completion: Mark Appropriate Certification Institution and location where degree completed Date of completion

Member Name: Signature: If member is under 18, a parent’s/legal guardian’s signature is required Parent/legal guardian’s name Signature Site Supervisor: Signature: SERVE Northern New England AmeriCorps Programs Coordinator: Laura Signature: Date: Date: Date:

Rooney
Date:

Once this contract has been signed by all parties, please keep one copy for the Member file, and return the original to the Vermont Campus Compact Office.