Initial Consultation Form

Single Competition and State Commission Input

Initial Consultation Form
Download
PDF or DOC

The New Mexico Commission is currently fielding calls and emails from multi-state programs who are interested in operating in New Mexico. The New Mexico Commission is responding based on the consultation process put in place that utilizes the form developed by the working group. The multi-state applicants need to hear back from the commissions prior to the January 26 deadline because they need to describe the consultation in their application to the Corporation.

Section 1311 of the SAA, Consideration of Applications, specifies that state commissions will provide input on national applications in their state: (f) Views of State Commission—In making competitive awards under section 129(d), the Corporation shall solicit and consider the views of a State Commission regarding any application for assistance to carry out a national service program within the State.

Hard copies of forms should be submitted to:
Attn: Anita Padilla, Commission Administrator
New Mexico Commission for Community Volunteerism
3401 Pan American Freeway, NE
Albuquerque, NM 87107

 

Consultation Form

Legal Applicant Information:



Organization (*)

Invalid Input
Contact Name (*)

Please type your full name.
Address (*)

Invalid Input
E-mail (*)

Invalid email address.
Phone (*)

Invalid Input
AmeriCorps Grant Type (*)






AmeriCorps Program Model (check one): (*)





Invalid Input
Type of Application (*)




Invalid Input


Proposed National Program Overview



Program Name

Invalid Input
Start Date:

Invalid Input
End Date:

Invalid Input

Number of AmeriCorps Slots



Minimum Time

Invalid Input
Quater Time

Invalid Input
Reduced Half Time

Invalid Input
2 Yr Half Time

Invalid Input
Half Time

Invalid Input
Full Time

Invalid Input


CNCS Budget Request within State



Total Operating Budget:

Invalid Input
Cost per MSY

Invalid Input
Number of MSYs

Invalid Input
Proposed Source of Match:

Invalid Input
AmeriCorps Program Focus:

Invalid Input
Description of Primary AmeriCorps Program Activities:

Invalid Input

Beneficiaries within the State:

Invalid Input
Prior Year Member Enrollment Rate:

Invalid Input
Prior Year Member Retention Rate:

Invalid Input
AmeriCorps Program Staff - No. of FTEs:

Invalid Input
Role of Parent in Administration of Program at state level:

Invalid Input
Skills and Resources to share:

Invalid Input
Date of most recent A133 Audit:

Invalid Input


Overview of Proposed Site(s)

For each proposed site, provide the following information: Operating site: sub-site; service site: exact location where member serves.

Proposed Site 1:



Operating or service site? Location of site and number of members:

Invalid Input

Proposed Site 2:



Operating or service site? Location of site and number of members:

Invalid Input

Proposed Site 3:



Operating or service site? Location of site and number of members:

Invalid Input

Proposed Site 4:



Operating or service site? Location of site and number of members:

Invalid Input
Please add bold letters:
Please add bold letters:
  Refresh
Invalid Input