Program Site Downloads

  

Welcome to the Program Site Downloads! In this section you will find the most up to date program forms and guidance for operating a Community HealthCorps program site.

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Include All 2011-2012 PROGRAM YEAR FORMS 2010-2011 PROGRAM YEAR FORMS PROGRAM MANAGEMENT AND GUIDANCE PROGRAM DEVELOPMENT AND TRAINING RESOURCES FISCAL ADMINISTRATION AND MONITORING PERFORMANCE MEASUREMENT COMMUNITY HEALTHCORPS LOGO

2011-2012 PROGRAM YEAR FORMS

Updated member forms, checklists, enrollment documents, etc. for the 2011-2012 program year (sorted by document title).

07-15-2011		Eligibility Verification Form (466kb )
07-20-2011		PSO Checklist 2011-12 (216kb )
07-20-2011		Member Contract 2011-12 (722kb )
07-20-2011		Enrollment Checklist (219kb )
07-26-2011		Member File System Checklist (120kb )
08-08-2011		Checklist for Exiting a Member (301kb )

2010-2011 PROGRAM YEAR FORMS

Updated member forms, checklists, enrollment documents, etc. for the 2010-2011 program year (sorted by document title).

08-10-2010		FORM-Independent Service Certification (287kb ) Verification for service hours outside the normal agency placement
08-10-2010		FORM-On-Call Hours Preauthorization (287kb ) Preauthorization form for service hours a member may earn when on-call for disaster relief, doula activities, and/or other related activities.
08-09-2010		FORM-2010-2011 Member Contract (final) (420kb ) Community HealthCorps Member Contract for all AmeriCorps members enrolled after August 16, 2010.
08-09-2010		FORM-Member Health Insurance Enrollment Waiver (265kb ) If AmeriCorps members choose to waive the offered health insurance, this form is to be completed as part of their file.
08-10-2010		Member File Checklist (271kb ) Simple, user-friendly checklist to organize member files
08-10-2010		FORM-Request for Slot Transfer (267kb ) Form to be completed when transferring a slot from program site to program site
08-10-2010		FORM-Member Performance (mid/end) Review 2010-2011 (296kb ) Form to complete mid and end of term reviews for all AmeriCorps members
08-10-2010		FORM-Independent Coursework Verification (265kb ) Verification form when confirming outside agency training hours
08-10-2010		FORM-Compelling Circumstance Exit Request (264kb ) Any AmeriCorps members requesting a personal compelling exit must complete this form, include requested documentation and seek approval from NACHC prior to the exit
08-10-2010		FORM-Change of Exit Date Form (266kb )
09-16-2010		Enrollment Form (36kb ) The Enrollment Form should be utilized as a roster representing benefit enrollees.
09-16-2010		Health Insurance Enrollment & Exit Guidance (278kb ) The guidance provides instructions on how to enroll and exit a member from the health insurance program.
09-16-2010		Health Insurance New Enrollment/Waiver Form (264kb ) This form should be utilized to either enroll a member in the health benefits plan, or opt them out of the plan during their time of service.
09-16-2010		Health Insurance Exit Form (266kb ) Completing this form ensures that a member is removed from health insurance coverage.
03-16-2011		AmeriCorps Enrollment Form (120kb ) To be used when the member does not complete his/her section in the My AmeriCorps Portal, and instead the program coordinator completes the entire enrollment.
03-16-2011		AmeriCorps Exit Form (101kb ) To be used when the member does not complete his/her section in the My AmeriCorps Portal, and instead the program coordinator completes the entire exit.

PROGRAM MANAGEMENT AND GUIDANCE

Tools to assist program sites manage their program and guidance updates throughout the service year

09-02-2009		Guidance-Member File Reviews & Site Visits (260kb )
09-16-2010		GUIDANCE-Member Health Insurance (278kb ) Guidance for enrolling and exiting HealthCorps members in health insurance
08-09-2010		GUIDANCE-Member Safety Safeguards (257kb ) Program Sponsors are responsible for implementing member safety safeguards as appropriate and necessary to ensure the safety of Community HealthCorps Member(s) serving at the Program Sponsor site(s).
08-10-2010		GUIDANCE-Standards for EAO Members (253kb ) If you are hosting Ed Award Only members, please review these standards
08-10-2010		GUIDANCE-Performance Reviews 2010-2011 (271kb )
08-10-2010		GUIDANCE-Payment of Living Allowance (258kb )
08-10-2010		GUIDANCE-Natl Svc Crim Hist Checks 2010-2011 (294kb )
08-10-2010		GUIDANCE-Max Utilization Policy 2010-2011 (256kb )
09-16-2010		Community HealthCorps Member Handbook 2010-2011 (411kb ) This handbook is designed to describe the Community HealthCorps and member roles.
09-17-2010		Description of Major Roles / Service Areas (489kb ) This resource describes the standard member roles and service areas for Community HealthCorps programs. May of the terms and definitions were adopted from www.AAPCHO.org, and other sources of published literature.
06-22-2011		GUIDANCE - Member Assignment Description (270kb ) Guidance on developing the Member Assignment Description
10-01-2010		GUIDANCE Member Activities and Roles (303kb )
10-01-2010		GUIDANCE Timekeeping and Service Hours (265kb )
10-27-2010		Education Award and Serving Multiple Terms (131kb ) This document provides guidance on the education award and serving multiple terms.
02-02-2011		Final Trust Rule Summary (224kb ) This informative training includes updates about the Edward M. Kennedy Serve America Act of 2009, and how this law affects the Segal AmeriCorps Education Award.
07-20-2011		Member Training Guidance (355kb )
07-26-2011		Guidance on Enrolling Members (170kb )
08-08-2011		Guidance on Exiting Members (337kb )

PROGRAM DEVELOPMENT AND TRAINING RESOURCES

Resources on how to recruit, retain, train, and recognize AmeriCorps members throughout the program year.

08-10-2010		Using Your Eli Segal Education Award (1016kb )
08-10-2010		Guide to Recruitment, Retention and Recognition (419kb )
01-09-2009		CNCS Overview (707kb ) Overview of the Corporation for National and Community Service, primary funding agency of the Community HealthCorps
09-14-2009		Creating Great Stories (259kb ) Great stories about the impact of Community HealthCorps can be shared by anyone! Follow this easy guide, and in no time you will be composing really great stories on your own.
09-16-2010		Site Supervisor Training 2010-2011 (963kb ) PowerPoint training to be used in training all HealthCorps Site Supervisors during the 2010-2011 Program Year

FISCAL ADMINISTRATION AND MONITORING

Tools for the fiscal monitoring and administration of Community HealthCorps grants

12-03-2009		Travel Reimbursement Form (111kb )
12-15-2010		Quarterly Fiscal Report Template 2010-2011 (61kb )
12-15-2010		Fixed Amount Grant Reimbursement Policy (292kb )
08-10-2011		Financial Management Survey (108kb )

PERFORMANCE MEASUREMENT

Tools to assist program sites monitor their progress on program performance measurements.

04-17-2009		Volunteer Satisfaction Survey (79kb ) This survey assesses the experiences community volunteers that serve as related to HealthCorps activity. Volunteer feedback is critical for learning more about improving programs, events, and volunteer recruitment and retention.
10-07-2010		A Member's Introduction to Performance Measurement (5506kb ) A presentation tool that helps to train members about performance measurement and data collection.
10-07-2010		Staff Introduction to Performance Measurement (5512kb ) A presentation tool that assists staff with training Community HealthCorps members about performance measurement and data collection.