NHC Chicago AmeriCorps 2021 Host Site Intent to Apply Thank you for your interest in hosting National Health Corps (NHC) Chicago AmeriCorps members. Please complete the following short survey to inform us of your intent to apply. OK Question Title * 1. Organization Name OK Question Title * 2. Primary Contact Name Title Email Address Phone Number OK Question Title * 3. How many NHC Chicago AmeriCorps members do you intend to apply for? OK Question Title * 4. Does your organization have experience hosting AmeriCorps members? Yes No OK Question Title * 5. Provide a brief description of the role you envision for the NHC Chicago AmeriCorps member. OK Question Title * 6. Would you like to receive technical assistance during the application process? Technical assistance may include: calls to review the RFA, the application, and/or the proposed position description.If yes, we will reach out to the contact person listed above. Yes No OK Question Title * 7. Please indicate if you have any other questions or concerns in the space below: OK DONE