2022-2023 DIAL/SELF AmeriCorps Program - Member Application
To apply for the DIAL/SELF AmeriCorps Program, please
1) complete this form,
2) email your resume to kscotto@dialself.org, and
3) submit 2 references (send them this link: https://forms.gle/iF56jD3tFDN11Dqh6 )

Members must be at least 18 years-old and U.S. citizens, U.S. nationals or lawful Permanent Residents. DSAP protects against discrimination on the basis of color, race, ethnicity, nationality, sex, political affiliation, sexual orientation, gender identity or expression, religion, or disability. We make reasonable accommodations for interviews and service.
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First and Last Name: *
Address (at time of application): *
City, State, Zip Code *
Email Address *
Phone (xxx) xxx-xxxx *
Are you at least 18 years old? *
Do you have a high school diploma / GED or equivalent? *
Are you a U.S. Citizen, U.S. National, or Lawful Permanent Resident? *
DSAP Members travel daily from home to site, as well as Friday Corps meetings in Northampton (weekly) and Greenfield (monthly). Please describe your reliable transportation. *
DSAP Members receive bi-weekly living stipends (about $1545/month before taxes). Most members are eligible for benefits such as SNAP, Fuel Assistance, and Loan Forbearance. Please consider any other resources/income you have access to and the expenses you are responsible for. *
Have you ever enrolled in an AmeriCorps program before? *
If yes, what type of program? Check all that apply.
Have you ever been released for cause from an AmeriCorps, VISTA, or NCCC program?
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How did you learn about the DIAL/SELF AmeriCorps Program?
Responses should be at least a paragraph each.
1) What are your long-term goals and how would participating in the DIAL/SELF AmeriCorps Program help you move towards your goals? What do you hope to gain from a year of service with youth? *
2) Please describe 3-5 personal qualities, skills, and/or values that you would contribute to the DIAL/SELF AmeriCorps team. Please provide examples from your personal or professional experiences that demonstrate these qualities. *
3) Please describe how you would like to incorporate creative skills, a creative approach, or arts into your support of young people. What experience do you have? *
It is critical for AmeriCorps Members to follow through with their commitment to the service that they provide to youth and the community. When Members leave the program, it impacts the youth, the organization, and their eligibility for the education award and future service opportunities.
4) Please describe how you have been reliable and accountable in the past. What motivates you to show up and bring your best self? *
5) Is there anything else you would like us to know in considering your application?
Satisfactory completion of a criminal history check is a requirement for participation in DIAL/SELF AmeriCorps. Criminal history checks are conducted by DIAL/SELF and include state criminal registry information checks in Massachusetts and in the applicant’s state of residence at the time they applied; FBI fingerprint check; and National Sex Offender Public Registry (NSOPW) check. If relevant information appears on the report(s), then DIAL/SELF may choose to complete a review process with the applicant. Any applicant listed or required to be listed on a sex offender registry or convicted of murder as defined and described in section 1111 of title 18, United States Code is ineligible to serve in any AmeriCorps-funded service stream, including AmeriCorps. Criminal history check information is kept in a locked file in the DIAL/SELF Administrative Office. Applicants will be given an opportunity to review their own criminal history check information. In accordance with CORI regulations, DIAL/SELF does not release criminal history check information to other agencies. Therefore, Site Partners follow their own policies regarding criminal history checks for applicants, and applicants may be asked to complete an additional check at their service sites.
I have read and understood this policy. *
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 for participation in some AmeriCorps programs, including AmeriCorps*NCCC, will require a physical examination, including drug and alcohol testing. Background and security checks may also be conducted by some programs.
      PRIVACY ACT NOTICE: The Privacy Act of 1974 (5 U.S.C & 552a) requires that the following notice be provided to you: The authority for collecting information from you in this application is contained in 42 U.S.C 12592 and 12615 of the National and Community Service Act of 1990 as amended, and 42 U.S.C 4953 of the Domestic Volunteer Service Act of 1973 as amended. You are advised that submission of the information is entirely voluntary, but the requested information is required in order for you to participate in AmeriCorps programs.
      The principal purpose for requesting this personal information is to process your application for acceptance into an AmeriCorps program, and for other general routine purposes associated with your participation in an AmeriCorps program. These routine purposes may include disclosure of the information to federal, state, or local agencies pursuant to lawfully authorized requests, to present and former employers, references provided by you in your application, and educational institutions, for the purpose of verifying the information provided by you in your application. In some programs, the information may also be provided to federal, state, and local law enforcement agencies to determine the existence of any prior criminal convictions. The information will not otherwise be disclosed to entities outside of AmeriCorps without your prior written permission.
I certify that all of the statements made in this application are true, correct, and complete, to the best of my knowledge. *
Date: *
Please email a resume that includes your education, work, and volunteer history. Email your resume to Kaydance Scotto, kscotto@dialself.org. *
Please request that two people submit a reference in order to complete your application to the DIAL/SELF AmeriCorps Program. (Reference form link: https://forms.gle/P6nJ6FRft7Mu8Jad7)

Select two people who know you well and who are familiar with your personal background, education, employment, and/or professional skills. Consider asking work supervisors, clergy, teachers, counselors, coaches, or someone else familiar with your motivation and community involvement.

Your application is not complete without these two references.

A link for your references will also be displayed when you submit this application.
I understand that it is my responsibility to request two references in order to have a complete application for the DIAL/SELF AmeriCorps Program. *
Thank you for applying to the DIAL/SELF AmeriCorps Program!
For more information, feel free to visit our website: www.dialself.org/americorps.html or email: kscotto@dialself.org or call: (413) 774-7054 ext. 101.
DIAL/SELF AmeriCorps serves the communities of Western Massachusetts in partnership with the Massachusetts Service Alliance, the State Commission on Community Service.
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