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. 

Question Title

* 1. Organization Name

Question Title

* 2. Primary Contact

Question Title

* 3. How many NHC Chicago AmeriCorps members do you intend to apply for?

Question Title

* 4. Does your organization have experience hosting AmeriCorps members?

Question Title

* 5. Provide a brief description of the role you envision for the NHC Chicago AmeriCorps member.

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.

Question Title

* 7. Please indicate if you have any other questions or concerns in the space below:

T