2009-2010 Printable Forms

Administrative Forms

• Housing Rehabilitation Sign-in Sheet
• Mileage Reimbursement- Site Related
• Off-Site Activity Request
• Personal/Emergency Contact information
• Training Request Form
• Vacation Request Form

Reporting Forms

Objectives tracking paperwork is a requirement of your service. All paperwork must be completed and turned in on time. At the end of the term, your completion of paperwork will be considered when determining your eligibility for the education award. We recommend making copies of all paperwork before turning it in. Use this list to track your requirements and check off items as you complete them.

Call Evie at 269-2024 if you are unsure about what you have turned in so far. Forms are available for download and print from the links below. Forms are also available at the Straight Up AmeriCorps office and Friday meetings.

Completed By

Form/Method

Due Dates

ALL

AmeriCorps Members

Participant Development Plan

Pre – Completed at Orientation

Activity Report - School Based

Activity Report - Non School Based

Due Monthly

9/30

10/31

11/30

12/31

1/31

2/28

3/31

4/30

5/31

Volunteer Record

Due Monthly – one per site

9/30

10/31

11/30

12/31

1/31

2/28

3/31

4/30

5/31

Success Story

One per year due. Sign up during orientation and record due date below.
Due Date____________________________

Site Evaluation

11/13/09
Early-Term (First of two)

Site Evaluation

6/4/10
Final (Second of two)

Program Evaluation

6/4/10

Participant Development Plan

6/4/10
Not in binder. Staff will give you a copy of your original

Final Project
(not required if you will be returning to the same site)

6/4/10

End of Term Exit Form

6/4/10 (Done at training)
Sign, do not date.
Will be submitted when all hours are completed!

Completed By

Form/Method

Due Dates

THE FOLLOWING POSITIONS:
City of Arcata, Consumer Credit Counseling, RCAA RICHES, and others TBD

Capacity Building Survey I

9/11/09
Initial Evaluation

Capacity Building Survey II

1/29/10
Mid term Evaluation

Capacity Building Survey III

6/4/10
Final Survey Due

Completed By

Form/Method

Due Dates

ONLY NON-School Based Positions

Workshop & Home Visit Sign-In Sheet

Due Monthly

9/30

10/31

11/30

12/31

1/31

2/28

3/31

4/30

5/31

Completed By

Form/Method

Due Dates

ONLY Members serving @ RCAA Energy Services & Housing Divisions

ENERGY EFFICIENCY Workshop & Home Visit Sign-In Sheet

Forms should be turned in once they are completely filled out.

Completed By

Form/Method

Due Dates

ONLY

School Based Mentoring Positions

Monthly Goal Setting Log (4)

Due Monthly

9/30

10/31

11/30

12/31

1/31

2/28

3/31

4/30

5/31

Tutoring Referral & Progress Form (4)
Teachers complete – members distribute and collect

9/11/2009
At least 4 referrals

Wellness Awareness Survey - Pre
NEW! Primary Grades
NEW! Secondary Grades

Pre – 9/29/09

NEW! Fitnessgram Score Sheet

Pre – 9/29/09

Tutoring Referral and Progress Form (4)

1/29/10
4 Mid-Term Assessments Due

Wellness Awareness Survey - Mid

1/29/10

Wellness Awareness Survey - Post

Post – 5/31/10

Tutoring Referral and Progress Form (4)

5/31/10
4 Final Assessments Due

COLOR KEY

Due Monthly

Due 9/11

Due 9/29

Due 11/13

Due 1/29

Due 5/31

Due 6/4

Redwood Community Action Agency
904 G St., Eureka, CA 95501
(707) 269-2024
E-mail: americorps@rcaa.org