AmeriCorps State Application

Name *

First

Middle

Last

Preferred Name, if different then above

Email Address *

Phone *

Current Address *

Address Line 1

City

State

Zip Code

AmeriCorps State position(s) you are applying for: (if you are an internal Public Health Corps Member please write "PHC" + the site) *

List all that you are interested in. If you are interested in any position, write 'any.'

How did you hear about Arizona Serve? *

Have you already spoken with an Arizona Serve staff member about the AmeriCorps program? If so, who? *

AmeriCorps Eligibility Requirements *

To serve in AmeriCorps, candidates must meet the above three requirements. If you meet the requirements, please check the boxes above.

Date of birth *

Have you previously served in AmeriCorps? *