Thank you for your interest in hosting National Health Corps (NHC) Chicago AmeriCorps members. Please complete the following short survey to inform us and to share your questions about the program.

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* 1. Organization Name:

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* 2. Primary Contact:

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* 3. How many NHC Chicago AmeriCorps members is your organization interested to host?

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

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

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* 6. Will you attend the optional Zoom Q&A* session on Thursday February 8, 2024 from 11:30am to 12:30pm CT?

*This optional Zoom Q&A session will be a space to address questions about the experience of hosting NHC AmeriCorps members and the host site application materials/process.

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* 7. Would you like to receive additional 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 listed above.

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

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