AmeriCorps VISTA
Preliminary HHCK Site Application 2016
Date Submitted: Click here to enter a date.
Type of Application: New to VISTAPrevious VISTA experience
AGENCY INFORMATION
Legal Name: Legal Status of Agency
Address:501 (c)3 charitable non-profit Government Agency
Other (please specify)
What is the mission/purpose of agency?
Describe the core programs of your agency. In other words, what does your organization do to fulfill its mission?
Give a short two to three sentence description of your intended VISTA project.
Identify VISTA Project Focus AreaOrganization Information
Economic Opportunity (financial literacy, housing, # of FT staff:
Employment)# of PT staff:
Healthy Futures (food resources)# of active community volunteers:
Veterans and Military FamiliesAnnual budget:
Age of organization:
Contact Information
Agency Director:
Director Phone Number:Email Address:
Contact Person regarding this application:Email Address:
Contact Phone Number:
Likely VISTA Supervisor:
Contact Phone Number:Email Address:
COMMUNITY NEED/PROJECT DESCRIPTION
- What are the goals of your potential VISTA project?
- What will a VISTA member do to accomplish these goals?
- Why is your project necessary (What is the community need driving this project? How big is the need? What is your evidence of the need?
- Why will it work? (What evidence do you have to support your project strategy?)
- What will success look like? (What will be different for your organization and your service beneficiaries when your goals are met?)
- How will you measure success? (You must have a plan for measuring your results!)
- How will you ensure that the population you intend to serve with this project has a voice in its development and implementation?
- VISTAs are a short-term resource to facilitate long-term change. How will your organization sustain the results of this VISTA project once it is completed?
ORGANIZATIONAL SUPPORT/PROJECT MANAGEMENT
- How will you provide the necessary support for a VISTA member?
- Why was the prospective Site Supervisor chosen?
- Do you currently have the resources necessary to support a VISTA member (cost share funds, office space, equipment and supplies, funds for service related mileage reimbursement, etc.)?
- How much service related travel do you anticipate your VISTA member doing during his/her service year (approximate number of miles)?
- Has your organization hosted a National Service member before?
If so, what kind and how long, how recently?
- If yes to the question above, how would your National Service member describe the experience with your organization?
- What specific skills and qualifications will you look for in a VISTA member so that he/she is successful in achieving your project goals and serving within your agency?
- Does your organization currently have other Corporation for National and Community Service (CNCS) resources? If yes, please list the type (AmeriCorps, Senior Corps, VISTA, etc.) and the number of members.
- Is your organization a current member of the Homeless and Housing Coalition of Kentucky (HHCK)? If yes, is your agency current on HHCK dues?
Note: Each agency awarded a HHCK VISTA and/or AmeriCorps State member must become a paying member of HHCK .
Please initial each box.
___IMPORTANT DISCLOSURE: Completing the information contained herein is in no way a promise that your organization will receive a VISTA member. HHCK is in the process of completing the application to become a VISTA intermediary and the information that you provide will assist in defining HHCK and partner site need, performance measures utilization, and possible site information to CNCS.
___HHCK staff will inform each site when we receive notification of approval from CNCS and will then take site application next steps.
___I understand that this is a preliminary application and that my organization may not be eligible or awarded a VISTA member. I agree that all answers are true to the best of my knowledge and experience with the organization.
Signature:Date: