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2. Thank you for your interest in partnering with the AmeriCorps Program for your event.

   The City of Dubuque AmeriCorps Program is a recipient of federal AmeriCorps grant funds associated with the grant application that was submitted by the program. Currently, the program's grant application is focused on Social-Emotional Learning for K-12th grade students, with direct SEL intervention in the schools for K-5 students, and SEL development through mentoring and life skill education for middle & high school students. 

   All requests for non-program related activities must be vetted by AmeriCorps Program staff to determine if AmeriCorps members can serve AmeriCorps hours at these requested events. This process is necessary due to the stringent guidelines placed around AmeriCorps funding. Violations of these guidelines can result in negative impacts to AmeriCorps members through the disallowance of AmeriCorps service hours and negative impacts to the program through significant financial penalties and even the termination of the program's AmeriCorps grant. 

   Thusly, all requests for AmeriCorps support outside of normal grant activities must be submitted through this form. Request submissions will be vetted by Program Staff and potentially Volunteer Iowa, our state compliance office, to ensure appropriateness. Submission of a request does not guarantee the approval of member service. 

   Additionally, approval of an event does not guarantee AmeriCorps members to serve at your event. All service that is alternative to their main service responsibilities is made optional for our members.

4. Organization Name*
5. Organization Type*
   -- Select One --Government AgencyNon-ProfitReligious InstitutionFor-Profit Agency
7. Organization Contact Name*
8. Organization Contact Phone*
9. Organization Contact Email*
11. Please provide the name of the event, the event date, and the timeframe(s) of when service is needed. Additionally, please provide the agenda of the event and a description of the potential activities that would be tasked to AmeriCorps Members.
13. Event Name*
14. Event Agenda Upload
16. Event Date(s)*
    Event Date(s) Start Date

    —

    Event Date(s) End Date
17. Timeframe of service activities*
    Timeframe of service activities Start Time

    —

    Timeframe of service activities End Time

    Please list the timeframe(s) of when service is needed.

19. What activities are you requesting AmeriCorps support for?*
21. Is the requested event associated with any of the following?*

    Please check all that apply:

    1. Pre-K/Early Childhood Youth
    2. K-5th Grade Youth

    1. Middle School Youth
    2. High School Youth

    1. Social-Emotional Learning
    2. Literacy

    1. Career Exploration
    2. Civic Engagementt
23. Please provide a justification for why your event needs AmeriCorps support to operate.*
27. Certification of adherence to AmeriCorps policies
29. Please certify that your request does not violate any of the following prohibited activities by checking the box next to each item.*

    Prohibited Activities: 45 CFR§§ 2520.65.
    While charging time to the AmeriCorps program, accumulating service or training hours, or otherwise performing activities associated with the AmeriCorps program or AmeriCorps, the Agency, members and volunteers recruited by members may not engage in the following activities:

    1. Attempting to influence legislation.
    2. Organizing or engaging in protests, petitions, boycotts, or strikes.
    3. Assisting, promoting or deterring union organizing.
    4. Impairing existing service agreements for services or collective bargaining agreements.
    5. Engaging in partisan political activities or other activities designed to influence the outcome of an election to any public office.
    6. Participating in, or endorsing, events or activities that are likely to include advocacy for or against political parties, political platforms, political candidates, proposed legislation, or elected officials.
    7. Engaging in religious instruction; conducting worship services; providing instruction as part of a program that includes mandatory religious instruction or worship; constructing or operating facilities devoted to religious instruction or worship; maintaining facilities primarily or inherently devoted to religious instruction or worship; or engaging in any form of religious proselytization.
    8. Providing a direct benefit to a business organized for profit.
    9. Providing a direct benefit to a labor union.
    10. Providing a direct benefit to a partisan political organization.
    11. Providing a direct benefit to a nonprofit organization that fails to comply with the restrictions contained in section 501(c)(3) of the Internal Revenue Code of 1986 related to engaging in political activities or substantial amount of lobbying except that nothing in these provisions shall be construed to prevent participants from participating in advocacy activities undertaken at their own initiative.
    12. Providing a direct benefit to an organization engaged in the religious activities described above in prohibited activity 7, unless CNCS assistance is not used to support the religious activities.
    13. Conducting a voter registration drive or using AmeriCorps funds to conduct a voter registration drive.
    14. Providing abortion services or referrals for receipt of such services.
    15. Any activity prohibited by applicable Executive Order/Memorandum
    16. Other such activities as AmeriCorps/Volunteer Iowa may prohibit. AmeriCorps members may not engage in the above activities; directly or indirectly by recruiting, training or managing others for the primary purpose of engaging in one of the activities listed above.
31. Non-Duplication and Non-Displacement: 45 CFR § 2540.100*

    Non-duplication. AmeriCorps assistance may not be used to duplicate an activity that is already available in the locality of a program. And, unless the requirements of paragraph (f) of this section are met, AmeriCorps assistance will not be provided to a private nonprofit entity to conduct activities that are the same or substantially equivalent to activities provided by a State or local government agency in which such entity resides.
    Non-displacement. An employer may not displace an employee or position, including partial displacement such as reduction in hours, wages, or employment benefits, as a result of the use by such employer of a participant in a program receiving AmeriCorps assistance.

    1. An organization may not displace a volunteer by using a participant in a program receiving AmeriCorps assistance.
    2. A service opportunity will not be created under this chapter that will infringe in any manner on the promotional opportunity of an employed individual.
    3. A participant in a program receiving AmeriCorps assistance may not perform any services or duties or engage in activities that would otherwise be performed by an employee as part of the assigned duties of such employee.
    4. A participant in any program receiving assistance under this chapter may not perform any services or duties, or engage in activities, that—
       1.  Will supplant the hiring of employed workers; or
       2. Are services, duties, or activities with respect to which an individual has recall rights pursuant to a collective bargaining agreement or applicable personnel procedures.
    5. A participant in any program receiving assistance under this chapter may not perform services or duties that have been performed by or were assigned to any—
       1. Presently employed worker;
       2. Employee who recently resigned or was discharged;
       3. Employee who is subject to a reduction in force or who has recall rights pursuant to a collective bargaining agreement or applicable personnel procedures;
       4. Employee who is on leave (terminal, temporary, vacation, emergency, or sick); or
       5. Employee who is on strike or who is being locked out.

    1. I certify that AmeriCorps participation in the proposed activity will not violate the federal Non-Displacement and Non-Duplication clause.
33. FUNDRAISING ACTIVITIES: 45 CFR § 2520.40*

    AmeriCorps Members may raise resources directly in support of Program service activities. Examples of allowable fundraising activities include, but are not limited to, the following:

    • Seeking donations of books from companies and individuals for a program in which AmeriCorps members teach children to read;
    • Securing supplies and equipment from the community to enable volunteers to help build houses for low-income individuals when the AmeriCorps project is building houses for low-income individuals; 

    Members may not:

    • Raise funds for his/her living allowance; raise funds for an organization’s operating expenses or endowment; 
    • Write a grant application for funding provided by a federal agency including Corporation for National Community Service grant proposals and AmeriCorps grants.

    The City of Dubuque AmeriCorps Program prohibits AmeriCorps Members from participating in any fundraising activities for any external entity due to the inability to track that the funding is not going towards an operating expense or endowment. AmeriCorps Members MAY participate in resource (books, clothing, food, etc) raising to benefit Dubuque Community Youth.

    1. I certify that the proposed activity is not a fundraiser.
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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

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