Email

Social Security Number

Hometown

If you are a lawful permanent resident alien, what is your registration number and card expiration date?

If yes, name used:

If yes, list all convictions, starting date, nature of offenses and where they occurred:

Education

If yes, which service?

Rank at separation:

Duties:

1. Why do you want to serve as an AmeriCorps Member with Mission: St. Louis Beyond School?

Please try to limit your responses to no more than 300 words.

2. How have you been involved with or served in your community? Why dedicating a year of your life to service important to you? Please include what you hope to contribute during your year of service as an AmeriCorps member as well as what you hope to gain from the experience.

Please try to limit your responses to no more than 300 words.

3. Describe your thoughts regarding the right of all students to have equal access to quality education.

Please try to limit your responses to no more than 300 words.

4. What kind of experiences have you had that you think have helped prepare you for working with diverse populations, including youth from low-income backgrounds?

Please try to limit your responses to no more than 300 words.

References

Please provide three professional references (name, email and phone number)

By signing below, I certify that all of the statements made in this application are true, correct, and complete, to the best of my knowledge, and are made in good faith. I understand that misinformation or omission of information could result in disqualification and/or termination as an AmeriCorps member. I also understand that my selection as an AmeriCorps member will require a National Criminal Background Check. I also indicate that I am prepared to serve a 12-month term of service with Mission: St. Louis Beyond School for the next year.

Typed name below

Beyond School AmeriCorps Member

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OFFICE HOURS:

ADDRESS:

PHONE NUMBER: