Welcome to Pa Mtn Service Corps

Complete this online application to be considered for service with the Pennsylvania Mountain Service Corps

Pennsylvania Mountain Service Corps Member Application. Please complete all sections.
First and Last Name		Home Phone		Are you interested in:	Full time Part time
		Cell Phone
Address	City	State	Zip	Email
check the counties where you are willing to serve
Armstrong Bedford Blair Cambria Centre Fayette Franklin Fulton Huntingdon Indiana Somerset Westmoreland
check the highest level of education completed
Non-high school grad GED High School Grad Some college credits

answer the following questions
Are you at least 17 years old?	yes no
Do you have reliable transportation?	yes no
Are you a US citizen or resident alien?	yes no
Have you ever served with AmeriCorps/Vista/NCCC?	yes no

If you have served with another AmeriCorps/Vista/NCCC program, please name the program?

How did you hear about the PMSC/AmeriCorps Program?

Please answer the following questions fully. Existence of criminal conviction/adjudication may or may not, depending on the circumstances, disqualify you from consideration. However, any intentional misrepresentation or omission will disqualify you. Do not include minor traffic violations.
If 17 years of age: have you ever been convicted, or adjudicated as a juvenile offender, of any criminal offense, other than minor traffic violations?		yes no
All Applicants: Are you currently	under charges for any criminal offense?	yes no
	on probation or parole?	yes no
Do you have anthing on record with the State Police Respository or the Department of Public Welfare that may bar you from participation in AmeriCorps?		yes no
All Applicants Certification
I understand that the Corporation for National And Community Service guidelines prohibits serving more than two terms in any AmeriCorps state or national program. I also understand that any misinformation or omission of information could result in may result in rejection of my application, dismissal from the program, and/or imposition of related fines and penalties.
Affirmed