Thank you for your interest in volunteering with the AmeriCorps Seniors program. Please complete this application so that we can ensure you are eligible and that the program will be a good match for you. The information you provide will be kep confidential and only pertinent staff at RurAL CAP will review it. Our program provides two different types of volunteering: Senior Companion (serving other adults) and Elder Mentor (serving youth). Applicants must be 55 or older and available to serve at least 5 hours/week. 

Once you complete this application we will reach out to you with the next steps of the onboarding process. 

This material is based upon work supported by AmeriCorps, the operating name of the Corporation for National and Community Service, under Grant No(s). 25SFIAK001, 24SCIAK001 and 26SDIAK001. Opinions or points of view expressed in this document are those of the authors and do not necessarily reflect the official position of, or a position that is endorsed by, AmeriCorps or AmeriCorps Seniors Program.

In order for a volunteer to recieve a stipend they must meet income guidelines per 45 CFR § 2552.43. Income levels vary based on the program and funding source. Even if you think you are over income we encourage you to still apply as there may still be oppotunities for you. If unsure, call us at 907-717-7932 before applying. Note: If LIVING with your spouse, include their income. No other household members' income is required.

Expenses: We are able to deduct eligible medical, up to 50% of your income. Please list any medical expenses for you and/or your spouse how frequently you incur these costs (monthly or annually) and how much each time.

I certify that the information funished above is correct and undstand that falsification of information may result in my being deemed ineligible to receive a stipend as an AmeriCorps Seniors. I understand that a knowing and willful false statement on this form can be punished by a fine or imprsionment or both under Section 1001 of Title 18, U.S.C.

In the event that informal efforts to resolve disputes are unsuccessful, AmeriCorps Senior Volunteers may seek resolution through the following grievance procedures. These procedures are intended to apply to volunteer service related issues, such as assignments, evaluations, suspension, or release for cause. In addition, individuals who are not selected as AmeriCorps Volunteer Seniors or labor unions alleging displacement of employees or duplication of activities by AmeriCorps may utilize these procedures.

Optional Alternative Dispute Resolution (ADR)

ADR must be chosen by the Volunteer within 45 days of a specific dispute. If the Volunteer chooses ADR as a first option, a neutral party designated by the program will attempt to facilitate a mutually agreeable resolution. The neutral party must not have participated in any previous decisions concerning the dispute. ADR is confidential, non-binding, and informal. No communications or proceedings of ADR may be referred to at the grievance hearing or arbitration stages. The neutral party may not participate in subsequent proceedings.

If ADR is chosen by the Volunteer, the deadlines for convening a hearing and of a hearing decision, 30 and 60 days respectively, are held in abeyance until the conclusion of ADR. At the initial session of ADR, the neutral party must provide written notice to the aggrieved party of his or her right to request a hearing. If ADR does not resolve the matter within 30 calendar days, the neutral party must again notify the aggrieved party of his or her right to request a hearing. At any time, the aggrieved party may decline ADR and proceed directly to the hearing process.

Grievance Hearing

A Volunteer may request a grievance hearing without participating in ADR, or, if ADR is selected, if it fails to facilitate a mutually agreeable resolution. The Volunteer must make a written request for a hearing and deliver it to their designated program supervisor. That request will then be reviewed and forwarded to the specific program director. The Community Development Division Director may also be involved at this step in handling a grievance. A request for a hearing must be made within one year after the date of the alleged occurrence. At the time a request for a hearing is made, the program should make available to the Volunteer information that it relied upon in its disciplinary decision.

Non-discrimination Statement - It is the policy of RurAL CAP to recruit, hire, train, and promote for all job classifications without regard to a person’s race, religion, color, national origin, age, physical or mental disability, sex, sexual orientation, marital status, changes in marital status, pregnancy, parenthood, veteran status, genetic information, or any other impermissible characteristic as defined by law when the reasonable demands of the position do not require distinction of the aforementioned items. RurAL CAP is committed to providing timely meaningful access for eligible individuals to volunteer opportunities, services and activities. RurAL CAP intends to provide meaningful access to programs to persons with Limited English Proficiency (LEP), within parameters that do not incur undue burden on RurAL CAP resources. If you have questions or concerns, or need a reasonable accommodation to participate in the Elder Mentor Program please contact please contact RurAL CAP AmeriCorps Senior Program Staff at 907-717-7932 or RurAL CAP HR department info@ruralcap.org

Privacy Statement - RurAL CAP will ensure that any Personal Identifiable Information (PII) that you provide in this application will not be shared with any party outside of the program staff. RurAL CAP utilizes an approved shredder for document disposal, as well as an encrypted email system for any documents that contain sensitive information; the IT Department has established processes and protocols for protecting all agency data. The information you provide in these forms will only be used for program eligibility checks, background checks, and program enrollment. All information will be kept in our secure systems and only necessary program staff will have access to it.

By signing below, I acknowledge that I have read and understand the following statements:

I hereby state that I am 55 years of age or older and offer my services as a volunteer for the RurAL CAP AmeriCorps Senior Volunteer Program. I understand that I am not an employee of the AmeriCorps Senior Volunteer Program, RurAL CAP, the volunteer station or the Federal Government.

I understand that in my capacity as an AmeriCorps Senior volunteer I may come into contact with confidential information. I agree to protect this information to the best of my ability and not to disclose it during or after my service as a volunteer has ended.

I understand that if I use my personal automobile in my volunteer service, I will arrange to keep in effect automobile liability insurance equal or greater to the minimum requirements of the state of Alaska. I will also keep in effect a valid Alaska Driver's license. 

I hereby confirm that the information provided in this application is true and accurate, and that my participation in this program is dependent on meeting background check requirements, income eligibility requirements, and adhering to program policies and procedures. I also acknowledge that I have received notice of my rights with regard to discrimination, Limited English Proficiency and reasonable accommodation, and that I have the right to pursue a resolution through the grievance process by contacting RurAL CAP’s Community Development Director at jmillett@ruralcap.org or 907-279-2511.