Cf enrollment packet cover sheet 10 11
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This document is an enrollment packet cover sheet for AmeriCorps Community Fellows in Pennsylvania. It requests basic member information such as name, SSN, date of birth, and email. It checks that the member has completed registration steps in MyServiceLog.org and encloses paperwork including a member contract, consent form, and copies of required background checks. The campus supervisor must sign to verify seeing documentation of the member's age and citizenship status.
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- 1. AmeriCorps Community Fellows Pennsylvania Campus Compact Enrollment Packet Cover Sheet 2010-2011 Please fill this form out completely and include it as the cover sheet for all relevant documents. Community Fellow Enrollment Information First Name: Middle Name: Last Name: SSN# (999999999): Date of Birth (mm/dd/yyyy): Email Address: Campus Name: Regisration in MyServiceLog.org: Completed all steps for member in "Guide to MyServiceLog" Enrollment Paperwork Enclosed: Member Contract Consent & Release Copies of Background Checks Enclosed: Criminal Background Check Child Abuse Clearance Sex Offender Check I certify that I have seen documents that verify this member's age and citizenship status. Acceptable documents include: passport, birth certificate AND government issued photo ID, INS Certificate of U.S. Citizenship, INS Certificate of Naturalization, or Alien Registration Acceptance Card. Signature of Campus Supervisor:__________________________________________________________ Pennsylvania Campus Compact * One College Avenue * Box 4508 * Grantham, PA 17027 * 717-796-5072 * 717-796-5078 (Fax)