Approved by OIRA 3045-0143 exp 10/31/2021 Program PurposeSchools of National Service benefits both post-secondary institutions and the AmeriCorps alumni they enroll. Recognizing that AmeriCorps alumni are an asset to the academic community, Schools of National Service seek to reward their service and incentivize their education by providing benefits to students who choose to serve. In return, institutions receive students who are trained leaders, community-minded, and driven to make a difference in the world.Section I: Profile Information Institution Information Name of Higher Education Institution * Specific Department or School * Website * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Primary Contact Information Contact Person First Name * Contact Person Last Name * Contact Person E-mail * Contact Person Phone * General Email Address Contact Person Fax Primary Contact Mailing Address Contact Person Street Address * City * State * - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code * President, Provost, or Dean who is certifying this Commitment Form (if different than Contact Person, above) First Name Last Name E-mail Phone Fax Institution Profile Type * Public Private Program Type * Please choose all that apply. 2-year degree (Associate) 4-year degree (Bachelor) Graduate Other Is Your Institution Eligible to Award Federal Student Aid Funds Based on * Please choose all that apply. Title IV VA Qualified Is Your Institution Please choose all that apply. Faith Based Tribal College Historically Black College/University Hispanic Serving Institution Section II: Commitment Level Detailed Description Provide a detailed description of what your institution is offering for the Schools of National Service Program. This language will be posted on our website and should clearly outline your institution’s commitment to AmeriCorps members and alumni. Include any benefits that your institution will offer to AmeriCorps members and alumni, as well as the dollar match for Segal AmeriCorps Education awards, if applicable. For a list of incentives an institution might provide,please see here.There are many options for becoming a School of National Service. However, educational institutions that select to match the Segal Education Award must provide a minimum match of $1,000 to be listed on the AmeriCorps website as a Schools of National Service matching institution. A dollar for dollar match is the preferred level of commitment from schools that participate in this program benefit. Please provide your description below * Matching Percentage Percentage of the award that your institution will match for an admitted AmeriCorps alumni The Segal AmeriCorps Education Award is tied to the maximum amount of the U.S. Department of Education’s Pell Grant. Refer to FAQs for more information. *Only AmeriCorps alumni who earned a Segal AmeriCorps Education Award are eligible for this program. To qualify for Segal AmeriCorps Education Award matching under the Schools of National Service Program, AmeriCorps alumni must have successfully completed their full term of service. Section III: Commitment TimeframeThis commitment to AmeriCorps is valid from the date of signature on this agreement until terminated or modified. If the institution needs to terminate this agreement, AmeriCorps must be notified to in order to delete the website listing; otherwise students will continue to contact the institution. AmeriCorps reserves the right to delete the website listing for any institution not in compliance with the Schools of National Service Program requirements. Commitment Timeframe Signature * Date * Leave this field blank Submit