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ARHP: Rural Health Corps - Service Member Application
  1. PLEASE EMAIL YOUR RESUME TO DANIELLE@ARRURALHEALTH.ORG 
  2. For the full position description, please email Dani Gibson at DANIELLE@ARRURALHEALTH.ORG
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Full Name: *
Who referred you for this position or how did you hear about it?  *
AmeriCorps members must be a United States citizen, U.S. national or lawful permanent resident.
Are you a United States citizen, national, or lawful permanent resident alien?
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Date of Birth:
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What is your sex?
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Earliest date you are available to begin service?
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Current Address: Street, City, State, Zip (All information will be sent to you at this address until you notify ARHP: Rural Health Corps of a change of address.)
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Phone Number: (please indicate home phone, work phone, cell phone) *
Email: *
Are you moving within the next six months?
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If yes, when?
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Emergency Contact/Permanent Address (if different than above): 

Please give the name, address, and phone number of a person through whom you can always be reached.
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The ARHP: Rural Health Corps is an AmeriCorps State and National Program. Is this the AmeriCorps program type you are wanting to apply to? 

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Check the highest level of education that you will have completed by the time you are planning to serve in AmeriCorps. (Check only one.)
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List all schools after high school that you have attended, including trade or technical schools, military training and employment training programs.

Please include School Name; Location; Dates Attended; Areas of Study; Degree/Certificate Awarded; and Date of Award. 
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Describe how you have reached out to help others and/or how you have been involved in your own community. Explain why you decided to serve or get involved, and what you received in return-that is, what you learned or how it made you feel. Think in broad
terms. List your most recent activity first. (Your involvement could include
serving in neighborhood, school, religious, social, professional, or other volunteer groups; helping out with community service projects;
or participating in less formal activities.)

Please include Organization Names and Dates of Involvement.
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We would like to understand more about you and your reasons for applying to an AmeriCorps program. Take a few minutes and consider those experiences which have made you the person you are today. Please share with us one of these experiences and how it sparked your interest in community service. 
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Beginning with the most current or most recent position, list and briefly describe the last four positions you have held or your last ten years of employment. Begin with the current or most recent and go back ten years. Include self-employment, internships/fellowships, home
management, and full- or part-time paid or unpaid work experience. 

If none, enter N/A
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Listed below are skill areas that some programs find useful and may seek in AmeriCorps applicants. Indicate the skill areas in which you have had training or experience, including volunteer or community service experience, and indicate how you gained those skills.
Please elaborate in detail on any selections made on the previous question. 

If none selected, enter N/A
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Do you know or have you studied any language(s) other than English?
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Please list Language(s), number of years studied or spoken, speaking ability, and writing ability.

Please indicate whether your speaking/writing ability is Poor, Fair, Good, or Excellent. 
Do you have a valid driver’s license?
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I understand that this position is not employment, but a service-learning national service position that receives a living allowance of $14,400 over the course of the term. This comes down to a pre-tax amount of approximately $654.55 every two weeks.  *
I am available to serve at least 25 hours a week for a (12) month term beginning September 1, 2024.  *
All ARHP: Rural Health Corps members are required to complete state and federal criminal background checks, sex offender registry checks, and child and adult maltreatment registry checks. Having something on your record does not necessarily disqualify you from serving, but failing to reveal any relevant information would mean termination from the program. Is there anything on your background that you would like to disclose? *
Have you served in an AmeriCorps, Peace Corps, or other national service program.  Please choose the appropriate answer(s) below.   *
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