• You will be able to identify specific position(s) that you wish to be considered for later on this form. The positions that are available should correspond to those listed on the Rural Health Service Corps website. If necessary, you may leave additional comments in the space provided at the end of the application. If you have questions, please contact the RHSC program staff using the information listed under "contact us" on the RHSC web site: www.ruralhealthservicecorps.org

    Your Contact Information:

  • Rural Health Service Corps (AmeriCorps/VISTA) Application

    Rural Health Service Corps (AmeriCorps/VISTA) Application
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  • Eligibility and Availability

  • Are you a US Citizen or Permanent Resident? You MUST be either a US Citizen or Permanent Resident with supporting documentation to be eligible for AmeriCorps.*
  • Please enter your date of birth for eligibility. Minimum age is 18:*
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  • Do you have previous AmeriCorps experience?*
  • Are you planning to relocate for your AmeriCorps VISTA position?

  • Time Frame for Service

  • Earliest date you can begin:*
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  • When MUST your service be done?*
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  • Most VISTA positions require members to be available Mon-Fri between 8:00 AM and 5:00 PM, for 35 hours/week. How many hours per week are you available during this time frame?*

  • Area(s) of Interest 



  • Please check all areas of skills and interests:*

  • Experience

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  • Upload a File
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  • References - Please provide at least two professional references. Our reference form is shared via email, so an email address is REQUIRED for each reference.

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  • Please tell us how you heard about the Rural Health Service Corps AmeriCorps program. Check all that apply:

  • "This program is available to all, without regard to race, color, national origin, disability, age, sex, political affiliation, or, in  most instances, religion."

    Electronic Signature Statement

    I understand that submission of this Rural Health Service Corps Application constitutes affixation of my electronic signature.  I verify that the information on this application accurately represents my candidacy and is true to the best of my knowledge.

    In the event of my active candidacy in the program, I authorize the Rural Health Network of South Central New York and the Rural Health Service Corps program staff to investigate any statement contained in this application, and to conduct necessary reference and criminal background checks to determine my qualification.

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