Self-Advocacy/Americorps Application
Please print a copy of this application using your browser's print command, then complete.

Name: _______________________________________

Date: ______________

Street Address:_________________________________

Phone # ( ___ )____-_______

City : ___________________________

State:_____

Zip Code:__________

Please answer the following questions. You may attach additional information if needed.
1. What skills and experience do you have that would aid in the mission of this project?
2. If chosen for this project, you would be a part of a team that would go out into the community (agencies, schools, civic organizations, etc.) to give presentations. Training is provided to all AmeriCorps members.
  • What does being part of a team mean to you?


  • What would you like best about being part of a presentation team?


  • What would you like least about being part of a presentation team?
3. Presentations and project work happens at different locations throughout the region. Our project is very flexible, however there are mandatory meetings and trainings. All members participate in community service to learn new skills and to complete their time commitment. Members work 9 – 35 hours per week.
  • Do you have dependable transportation?


  • Are you currently participating in: (Circle all that apply) Day Habilitation, Day Treatment, Work, Sheltered Work, Supported Work, School, or training?


  • Could your AmeriCorps participation be incorporated into your current program, job, or would you need to make other arrangements?
List two references (previous employers, teachers, co-workers) that we may contact:

Name: _____________________ Phone:______________
Relationship: __________________________
Street Address:______________________
City __________ State ______ Zip ________

Name: _____________________ Phone:______________
Relationship: __________________________
Street Address:______________________
City __________ State ______ Zip ________

Do you have a Birth Certificate? Yes or No
Do you have a : High School Diploma, IEP GED (Please circle one)

AmeriCorps is a national initiative signed into law by President Clinton in 1993. AmeriCorps service brings individuals of all ages and backgrounds together to address the nation’s educational, environmental, human, public safety, and homeland security needs. Through service, they bring to life the AmeriCorps ethic of community and responsibility.

The Self Advocacy Association of New York State, Inc. has an exciting project through AmeriCorps. The mission of the AmeriCorps/Self Advocacy Project is to assist individuals with developmental disabilities to become full and valued members of their communities. Through this project, individuals with developmental and other disabilities work under the concept that "Our Experience is the Best Teacher." With this in mind, teams of AmeriCorps members make presentations on a number of related topics to students with and without disabilities, service agencies, people interested in self-advocacy, staff of support agencies and members of the general community. The purpose of these presentations is to promote the importance of self-advocacy for people with disabilities, to promote general awareness of disability related issues and to teach about the importance of full community inclusion and participation of all individuals in their community.

As an AmeriCorps program, the Self Advocacy Association has opportunities for individuals to serve as AmeriCorps members. Members receive a modest living allowance as a stipend and are eligible for educational awards. Individual health care coverage and child care subsidy, if needed, are also provided to full time members.

Annual Stipend

Monthly

Health Care

EducationalAward

Hours per Week

$ 10,600

$ 883

Yes

$ 4,725.00

35 =Full Time

$ 4,052

$ 338

No

$ 2,362.50

17 = Half Time

$ 2,026

$ 169

No

$ 1,250.00

9 = Quarter Time
Send completed applications to:

Self-Advocacy Association of New York, Inc.
AmeriCorps Program Coordinator
500 Balltown Road Building 5C
Schenectady, NY 12304