1. AmeriCorps Community Fellows
Pennsylvania Campus Compact
Enrollment Packet Cover Sheet 2010-2011
Please fill this form out completely and include it as the cover sheet for all relevant documents.
Community Fellow Enrollment Information
• First Name:
• Middle Name:
• Last Name:
• SSN# (999999999):
• Date of Birth (mm/dd/yyyy):
• Email Address:
• Campus Name:
Regisration in MyServiceLog.org:
Completed all steps for member in "Guide to MyServiceLog"
Enrollment Paperwork Enclosed:
Member Contract
Consent & Release
Copies of Background Checks Enclosed:
Criminal Background Check
Child Abuse Clearance
Sex Offender Check
I certify that I have seen documents that verify this member's age and citizenship status. Acceptable
documents include: passport, birth certificate AND government issued photo ID, INS Certificate of U.S.
Citizenship, INS Certificate of Naturalization, or Alien Registration Acceptance Card.
Signature of Campus Supervisor:__________________________________________________________
Pennsylvania Campus Compact * One College Avenue * Box 4508 * Grantham, PA 17027 * 717-796-5072 * 717-796-5078 (Fax)