Member Application

(Use your legal name that matches your identification documents)

Jumpstart does not discriminate on the basis of gender identity or expression. We request this information for the purpose of helping our staff use the most respectful language when addressing you.

To enroll as a Jumpstart member, proof of your identity will be required upon acceptance. To enroll in Jumpstart as an AmeriCorps member, you must be a U.S. citizen, U.S. national, or legal, permanent resident and be able to provide proof of such status.

(Social security numbers will be used for criminal history checks and identity verification within our systems.)

(Social security numbers will be used for criminal history checks and identity verification within our systems.)

(This may be a school id or other number unique to yourself that you do not expect to change. Personal identification numbers will be used for identity verification within our systems.)

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Federal Work-Study

Your Contact Information

Mailing Address of Residence during Service Term

Permanent Mailing Address

Address at which you can always be reached, e.g. parent/guardians' address

Emergency Contact Information

In accordance with federal, state and local regulations governing our work with children, all applicants must consent to a criminal history check, and selection into the program is contingent upon Jumpstart's review of the applicant's criminal history, if any. Criminal history checks may be conducted through federal, state and/or third-party consumer reporting agencies, and may include a fingerprint check or other screening service. Please note that anyone who is required to register on a state sex offender registry or who is convicted of murder is automatically ineligible to serve.

Applicants may need to provide health documentation (such as TB tests, vaccinations, and other results) as required by state or local regulation in order to serve in preschool settings


Please list any languages you speak other than English, and for each, indicate level of proficiency:


Please select all the times that you will be available to serve with Jumpstart and indicate the days. Occasional evening and weekend hours may be required for trainings, service days, etc. A copy of your schedule may be requested, and more information about exact service times will be shared during the interview process.


By signing below, I attest that all statements made in this application are accurate and truthful and understand that any misrepresentations or false statements made in this application may result in not being considered for service, and that if not discovered by Jumpstart until after acceptance, such misrepresentations could be grounds for immediate termination. *

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Jumpstart is an equal opportunity organization and encourages applications from all individuals without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, amnesty, political affiliation, or status as a covered veteran in accordance with all applicable federal, state and local laws. Qualified individuals with disabilities are strongly encouraged to apply. Jumpstart will make reasonable accommodations for qualified individuals throughout the application process and during Jumpstart service. Accommodation requests should be directed to the Jumpstart office to which you are applying. Jumpstart is a proud member of the AmeriCorps national service network. Please note that not all Jumpstart sites are directly supported by AmeriCorps. Please contact the site to which you are applying for more information.