MOU RE REFUGEE RESETTLEMENT PROGRAM WITH ADES.PDF

MEMORANDUM OF UNDERSTANDING
(MOU)
VISTA Project Number:
DES Number:
Between the Sponsor:
State of Arizona
Department of Economic Security
Division of Aging and Adult Services
Melanie K. Starns, Assistant Director
1789 West Jefferson Site Code 950A
Phoenix, Arizona 85007
602-542-6365
And the Participating Agency:
Maricopa County Department of Public Health
1645 E. Roosevelt St
Phoenix, AZ 85006
This document defines the responsibilities of the Sponsor and the Participating Agency with respect to the assignment of
AmeriCorps*VISTA member(s) to perform services to strengthen and supplement efforts to eliminate poverty and
poverty-related human, social and environmental problems. The Sponsor and the Participating Agency shall ensure that
all services provided are culturally relevant and linguistically appropriate to the population to be served. Due to the
refugee-specific experience and knowledge required to perform these services, it is in the best interest of the Sponsor to
contract with Participating Agencies who have met the criteria for participation in the project and have expressed an
interest to participate with the AmeriCorps*VISTA Project. (Criteria listed in Participating Agency section 4.)

1. Duration
1.1 This Memorandum of Understanding (MOU) shall be in effect on the date of last signature and shall terminate on
September 6, 2014.
2. Modifications
2.1 This MOU may be amended at any time in writing with an executed amendment signed by authorized
representatives of the Sponsor and the Participating Agency.
3. Termination
3.1 The Sponsor or the Participating Agency may terminate this MOU at any time by giving at least thirty (30) days’
notice in writing to the Sponsor or the contractor of its intent. Further, this MOU shall terminate if the
Participating Agency materially fails to comply with any of its terms.
4. Responsibilities
4.1 The Sponsor will:
1. Assist AmeriCorps*VISTA Participating Agencies in developing work plans for each assignment.
2. Assist in the provision of pre-service, early service, and in-service training.
3. Plan meetings for project supervisors and for AmeriCorps*VISTA member(s) ongoing training as needed or
recommended by the Corporation for National and Community Service (CNCS).
4. Provide a current listing of Participating Agencies to be used for collaboration with other refugee-serving
Participating Agencies in developing and delivering services under this contract.
5. Assign AmeriCorps*VISTA member(s) to Participating Agencies, matching interests and skills with tasks
outlined in the work plan.
6. Provide support and supervision to Participating Agencies in administrative matters such as project
assignments and monthly reporting.
7. Retain full responsibility for the management and semi-annual reporting of the AmeriCorps*VISTA Project as
outlined by the Corporation for National and Community Service AmeriCorps*VISTA program.
8. Transfer an AmeriCorps*VISTA member(s) from one placement to another consistent with the work plan and
Participating Agency needs.
9. Retain full responsibility for media contacts about member(s) and their work.
10. Provide Participating Agency evaluations.
11. Provide member(s) support.
12. Conduct fingerprinting, as required in Section 19.
13. Conduct background checks on AmeriCorps*VISTA member(s).
4.2 The Participating Agency shall:
1. Provide services to refugees and other eligible beneficiaries.
2. Leverage local, national and global resources to accommodate the need resulting from the increasingly
unpredictable United States refugee admission trends in recent years and a greater array of arriving refugees
with corresponding unique needs.
3. Submit proof of their non-profit status which can be any one of the following:
1. A reference to the applicant organization's listing in the IRS's most recent list of tax-exempt organizations
described in the IRS Code.
2. A copy of a currently valid IRS tax-exemption certificate.
3. A statement from a State taxing body, State attorney general, or other appropriate State official certifying
that the applicant organization has non-profit status and that none of the net earnings accrue to any private
shareholders or individuals.
4. A certified copy of the organization's certificate of incorporation or similar document that clearly
establishes non-profit status.
5. Any of the items in the subparagraphs immediately above and a statement signed by the organization that
the applicant organization is a local non-profit affiliate.
4. Provide quarterly written reports of collaboration with other refugee-serving agencies in developing and
delivering services under this contract.

5. Develop an AmeriCorps*VISTA Assignment Description (VAD) (Attachment A) that corresponds to the
milestones in the Refugee Resettlement Program (RRP) Project Plan (Attachment B).
4.3 The Participating Agency shall designate a site supervisor who shall attend an AmeriCorps*VISTA supervisor
training as required by AmeriCorps*VISTA program and who shall:
1. Within 10 days after date of last signature, and prior to the placement of the AmeriCorps*VISTA member(s),
the Participating Agency shall submit a VAD to RRP for approval. The VAD shall include a schedule for
completing the work and a budget. (Attachment C.) These items shall be in sufficient detail to provide a
sound basis for the Sponsor to effectively monitor performance under this MOU.
The approved VAD may be revised with the approval of RRP.
2. Provide day-to-day supervision of the activities of the AmeriCorps*VISTA member(s).
3. Provide AmeriCorps*VISTA member(s) with timely information and supervision to ensure the bi-weekly
time sheets and a quarterly report template can be completed and sent to the Sponsor on or before due dates.
4. Provide reimbursement for public transportation or mileage for AmeriCorps*VISTA member(s) if the travel
is part of the work plan.
5. Provide materials and supplies related to the performance of assignments and adequate working space to
permit AmeriCorps*VISTA member(s) to perform their assigned duties.
6. Cooperate with the Sponsor in implementing the individual career development plan for each
AmeriCorps*VISTA member(s).
7. Assist, when requested by the Sponsor, in reviewing performance of AmeriCorps*VISTA member(s).
8. Notify the Sponsor immediately regarding unscheduled termination of AmeriCorps*VISTA member(s) and
unscheduled changes of status and conditions of AmeriCorps*VISTA member(s), such as arrests,
hospitalization, and absence without leave.
9. Maintain records regarding time sheets and reports and investigations concerning matters involving
AmeriCorps*VISTA member(s). The Participating Agency agrees to retain such records as the Sponsor may
require for a period of five years after completion or termination of the project, or longer if required for
administrative proceedings and/or litigation purposes, and to provide access to such records to the Sponsor for
the purpose of litigation, audit or examination. All records shall be subject to inspection and audit by the State
at reasonable times. Upon request, the Participating Agencies shall produce a legible copy of any or all such
records.
10. Allow AmeriCorps*VISTA member(s) to participate in local emergency disaster relief efforts if needed.
11. Allow AmeriCorps*VISTA member(s) to participate in Days of Service, i.e., Martin Luther King Holiday,
National Volunteer Week, World Refugee Day, should activities be organized in the communities where the
member(s) is (are) in service.
4.4 The Participating Agency further agrees not to:
1. Carry out projects resulting in the identification of such projects with partisan or non-partisan political
activities, including voter registration activities, or providing voters transportation to the polls.
2. Assign AmeriCorps*VISTA member(s) to activities that would result in the firing of or result in the
displacement of employed workers, or impair existing contracts for services.
3. Accept, or permit the acceptance of compensation from the AmeriCorps*VISTA member(s) or from
beneficiaries for the service of the AmeriCorps*VISTA member(s).
4. Approve the involvement of any AmeriCorps*VISTA member(s) assigned to it in planning, initiating,
participating in, or otherwise siding or assisting in any demonstrations whatsoever in their capacity as an
AmeriCorps*VISTA member.
4.5 Both parties to this Memorandum of Understanding shall:
1. Make every reasonable effort to ensure that the health and safety of the AmeriCorps*VISTA member(s) is
(are) protected during the performance of their assigned duties. Neither the Sponsor nor the Participating
Agency shall assign or require AmeriCorps*VISTA members to perform duties which would jeopardize their
safety or cause them to sustain injuries.
2. Ensure that persons selected as AmeriCorps*VISTA members are not related by blood or marriage to project
staff, sponsor staff, officers or members of the sponsor’s Board of Directors, or responsible Corporation
program staff.

5. Supplemental Payments Prohibited
5.1 Monetary subsistence allowances provided to AmeriCorps*VISTA members are designed to permit
AmeriCorps*VISTA member(s) to live at or below the economic level of the persons served, as required by law.
Both the Sponsor and the Participating Agency are strictly prohibited from supplementing these allowances.
6. Notices
6.1 The Participating Agency shall address all correspondence regarding this agreement to the Refugee Resettlement
Program AmeriCorps*VISTA Project coordinator at:
Department of Economic Security
Division of Aging and Adult Services
Refugee Resettlement Program
1789 West Jefferson, Site Code 950A
Phoenix, Arizona 85007
602-542-6365
6.2 The Sponsor shall address all correspondence regarding this agreement to:
Maricopa County Department of Public Health
Angelito Bravo
1645 E. Roosevelt
Phoenix, AZ 85006
AngelitoBravo@mail.maricopa.gov
7. Payments
7.1 The Participating Agency shall not be reimbursed for any expenses within the AmeriCorps* VISTA project grant
cycle.
8. Applicable Law
8.1 This MOU shall be governed and interpreted by the laws of the State of Arizona.
9. Arbitration
9.1 The parties to this MOU agree to resolve all disputes arising out of or relating to this MOU through arbitration,
after exhausting applicable administrative review, to the extent required by A.R.S. § 12-1518, except as may be
required by other applicable statutes (Title 41).
9.2 The parties agree that should a dispute arise between them concerning this Agreement and no party seeks
affirmative relief other than money damages in the amount of Fifty Thousand Dollars ($50,000) or less, exclusive
of interest, costs and attorneys’ fees, the parties shall submit the matter to arbitration pursuant to the Revised
Uniform Arbitration Act, A.R.S §12-3001 et seq. (the “Act”) whose rules shall govern the interpretation,
enforcement, and proceedings pursuant to this section. Except as otherwise provided in the Act, the decision of
the arbitrator(s) shall be final and binding upon the parties.
10. Non-Availability of Funds
10.1 Every payment obligation of the State under the MOU is conditioned upon the availability of funds appropriated
or allocated for payment of such obligation. If funds are not allocated and available for the continuance of this
MOU, this MOU may be terminated by the State at the end of the period for which funds are available. No
liability shall accrue to the State in the event this provision is exercised, and the State shall not be obligated or
liable for any future payments of for any damages as a result of termination under this paragraph.
11. Availability of Funds for the Current State Fiscal Year
11.1 Should the State Legislature enter into session and reduce the appropriations or for any reason and these goods or
services are not funded, the ADES may take any of the following actions:
1. Reduce the number of AmeriCorps*VISTA members authorized;

2. Cancel the MOU
3. Cancel the MOU and re-write the requirements.
12. Availability of Funds for the Next State Fiscal Year
12.1 Funds may not presently be available for performance under this MOU beyond the current state fiscal year. If
funds are not allocated and available for the continuance of this MOU, this MOU may be terminated by the
Sponsor at the end of the period for which funds are available.
12.2 No liability shall accrue to the Sponsor in the event this provision is exercised, and the DES shall not be obligated
or liable for any future payments of for any damages as a result of termination under this paragraph.
13. Cancellation for Conflict of Interest
13.1 Pursuant to A.R.S. §38-511, the State, its political subdivisions or any department or agency of either may, within
three years after its execution, cancel any MOU without penalty or further obligation, made by the State, its
political subdivisions or any department or agency of either if any person significantly involved in initiating,
negotiating, securing, drafting or creating the MOU on behalf of the State, its political subdivisions or any
department or agency of either is, at any time while the MOU or any extension of the MOU is in effect, an
employee or agent of any other party to the MOU in any capacity or a consultant to any other party to the MOU
with respect to the matter of the MOU. A cancellation made pursuant to this provision shall be effective when the
Participating Agency received written notice of the cancellation, unless the notice specifies a later time.
14. Culturally Relevant and Linguistically Appropriate
14.1 The Participating Agency shall ensure that all services provided are culturally relevant and linguistically
appropriate to the population to be served.
15. Iran and Sudan
15.1 In accordance with A.R.S. § 35-393.06, the Participating Agency certifies that the Participating Agency does not
have scrutinized business operations in Iran.
15.2 In accordance with A.R.S. § 35-391.06, the Participating Agency certifies that the Participating Agency does not
have scrutinized business operations in Sudan.
16. Data Sharing Agreement
16.1 When determined by the Sponsor that sharing of confidential data will occur with the Participating Agency, the
Participating Agency shall complete the DES Data Sharing Request Agreement and submit the completed
Agreement to the Sponsor program designated staff prior to any work commencing or data shared. A separate
Data Sharing Request Agreement shall be required between the Participating Agency and each sponsor program
sharing confidential data.
17. E-Verify
17.1 The Participating Agency certifies compliance with all Federal immigration laws and regulations relating to
AmeriCorps*VISTA Member(s) and certifies its compliance with Section A.R.S. § 23-214, subsection A. (That
subsection reads: “After December 31, 2007, every employer, after hiring an employee, shall verify the
employment eligibility of the employee through the E-Verify program.”)
17.2 A breach of a certification regarding compliance with immigration laws and regulations shall be deemed a
material breach of the MOU and the Participating Agency may be subject to penalties up to and including
termination of the MOU.
17.3 Failure to comply with a State audit process to randomly verify the records of Participating Agency and
subcontractors shall be deemed a material breach of the MOU and the Participating Agency may be subject to
penalties up to and including termination of the MOU.
17.4 The Sponsor retains the legal right to inspect the papers of any AmeriCorps*VISTA member who works on the
MOU to ensure that the Participating Agency or subcontractor is complying with the certifications under the first
paragraph.

18. Federal Immigration and Nationality Act
18.1 By entering into the MOU, the Participating Agency certifies compliance with the Federal Immigration and
Nationality Act. (FINA) and all other Federal immigration laws and regulations related to the immigration status
of its AmeriCorps*VISTA member(s). The Participating Agency shall obtain statements from its subcontractors
certifying compliance and shall furnish the statements to the Procurement Officer upon request. These
certifications shall remain in effect through the term of the MOU. The Participating Agency and its
subcontractors shall also maintain Employment Eligibility Verification forms (I-9) as required by the U.S.
Department of Labor’s Immigration and Control Act, for all AmeriCorps*VISTA member(s) performing work
under the MOU. I-9 forms are available for download at USCIS.GOV.
18.2 The State may request verification of compliance for any Participating Agency or subcontractor performing work
under the MOU. Should the State suspect or find that the Participating Agency or any of its subcontractors are
not in compliance, the State may pursue any and all remedies allowed by law, including, but not limited to
suspension of work, termination of the MOU for default, and suspension and/or debarment of the Participating
Agency. All costs necessary to verify compliance are the responsibility of the Participating Agency.
19. Fingerprinting
19.1 Participating Agency shall ensure that AmeriCorps*VISTA member(s) comply with all applicable (current and
future) legal requirements relating to fingerprinting, fingerprint clearance cards, certifications regarding pending
or past criminal matters, and criminal records checks that relate to contract performance.
19.2 Applicable legal requirements relating to fingerprinting, certification, and criminal background checks may
include, but are not limited, to the following: A.R.S. §§ 36-594.01, 36-3008, 41-1964, and 46-141. All
applicable legal requirements relating to fingerprinting, fingerprint clearance cards, certifications regarding
pending or past criminal matters, and criminal records checks are hereby incorporated in their entirety as
provisions of this contract. The Participating Agency is responsible for knowing which legal requirements
relating to fingerprinting, fingerprint clearance cards, certifications regarding pending or past criminal matters,
and criminal records checks relate to MOU performance.
19.3 To the extent A.R.S. § 46-141 is applicable to contract performance or the services provided under this MOU, the
following provisions apply:
19.3.1 AmeriCorps*VISTA member(s) who are employed by the Participating Agency, whether paid or not, and who are
required or allowed to provide services directly to juveniles or vulnerable adults shall have a valid fingerprint
clearance card or shall apply for a fingerprint clearance card within seven working days of employment.
19.3.2 Except as provided in A.R.S. § 46-141, this MOU may be cancelled or terminated immediately if an
AmeriCorps*VISTA member employed by the Participating Agency and who has contact with juveniles certifies
pursuant to the provisions of A.R.S. § 46-141 (as may be amended) that the AmeriCorps*VISTA member is
awaiting trial or has been convicted of any of the offenses listed therein in this State, or of acts committed in
another state that would be offenses in this State, or if the AmeriCorps*VISTA member does not possess or is
denied issuance of a valid fingerprint clearance card.
20. Background Checks for Employment through the Central Registry. If providing direct services to children or
vulnerable adults, the following shall apply:
20.1 The provisions of A.R.S. § 8-804 (as may be amended) are hereby incorporated in its entirety as provisions of this
MOU.
20.2 The Sponsor will conduct Central Registry Background Checks and will use the information contained in the
Central Registry as a factor to determine qualifications for AmeriCorps*VISTA members that provide direct
service to children or vulnerable adults for:
1. Any person who applies for a contract with this State and that person’s employees;
2. All employees of a contractor;

3. A subcontractor of a contractor and the subcontractor’s employees; and
4. Prospective employees of the contractor or subcontractor at the request of the prospective employer.
20.3 AmeriCorps*VISTA members who provide direct services to children or vulnerable adults shall have a Central
Registry Background Check (Attachment D as may be amended) which is to be used as a factor to determine
qualifications for their positions.
20.4 1. An AmeriCorps*VISTA member who is disqualified because of a Central Registry Background Check may
apply to the Board of Fingerprinting for a Central Registry exception pursuant to A.R.S. § 41-619.57. An
AmeriCorps*VISTA member who is granted a Central Registry exception pursuant to A.R.S. § 41-619.57 is
not entitled to a contract, employment, licensure, certification or other benefit because the person has been
granted a Central Registry exception.
2. Before being employed or volunteering in a position that provides direct services to children or vulnerable
adults, AmeriCorps*VISTA members shall certify on forms that are provided by the Sponsor whether an
allegation of abuse or neglect was made against them and was substantiated. The completed forms are to be
maintained as confidential.
20.5 The AmeriCorps*VISTA member shall not provide direct services to Sponsor clients until the results of the
Central Registry Background Check are complete and the results indicate that the AmeriCorps*VISTA member
has no disqualifying acts that would prohibit him/her from providing services to Sponsor clients. If the Central
Registry Background Check specifies any disqualifying act and the AmeriCorps*VISTA member does not have a
Central Registry exception, the AmeriCorps*VISTA member shall be prohibited from providing direct services to
Sponsor clients.
20.6 The Participating Agency shall maintain the Central Registry Background Check results and any related forms or
documents in a confidential file for five (5) years after termination of the MOU.
21. Non-Discrimination
21.1 No person with responsibilities in the operation of the project shall discriminate against any AmeriCorps*VISTA
member(s), or member(s) of the staff of, or beneficiary of the project, with respect to any aspect of the project on
the basis of race, religion, color, national origin, sex, age, disability, or political affiliation.
22. Offshore Performance of Work Prohibited
22.1 Due to security and identity protection concerns, direct services under this contract shall be performed within the
borders of the United States. Any services that are described in the specifications or scope of work that directly
serve the State of Arizona or its clients and may involve access to secure or sensitive data or personal client data
or development or modification of software for the State shall be performed within the borders of the United
States. Unless specifically stated otherwise in the specifications, this definition does not apply to indirect or
“overhead” services, redundant back-up services or services that are incidental to the performance of the contract.
This provision applies to work performed by subcontractors at all tiers.
23. Pandemic Contractual Performance
23.1 The Department shall require a written plan that illustrates how the Participating Agency shall perform up to
contractual standards in the event of a pandemic. The state may require a copy of the plan at any time prior or post
award of a contract.
23.2 At a minimum, the pandemic performance plan shall include:
1. Key succession and performance planning if there is a sudden significant decrease in the Project
Station’s workforce.
2. Alternative methods to ensure there are services or products in the supply chain.
3. An up to date list of company contacts and organizational chart.
23.3 In the event of a pandemic, as declared by the Governor of Arizona, U.S. Government or the World Health
Organization, which makes performance of any term under this contract impossible or impracticable, the State
shall have the following rights:

1. After the official declaration of a pandemic, the State may temporally void the contract(s) in whole or specific
sections if the Participating Agency cannot perform to the standards agreed upon in the initial terms.
2. The State shall not incur any liability if a pandemic is declared and emergency procurements are authorized
by the Director of the Arizona Department of Administration per A.R.S. § 41-2537 of the Arizona
Procurement Code.
3. Once the pandemic is officially declared over and/or the Participating Agency can demonstrate the ability to
perform, the State, at its sole discretion may reinstate the temporarily voided contract(s).
24. Legal Restrictions
24.1 The Participating Agency agrees that no AmeriCorps*VISTA member(s) assigned under this MOU shall
participate in the following activities when they would result in the identification of such programs with:
1. Partisan and non-partisan political activities, including voter registration.
2. Direct or indirect attempts to influence passage or defeat of legislation or proposals by initiative petition.
3. Labor or anti-labor organization or related activities.
4. Religious instruction, worship services, proselytization, or any other religious activity as an official part of
their duties.
AUTHORIZED SIGNATORY: PARTICIPATING AGENCY:
The State of Arizona Maricopa County Department of Public Health
Department of Economic Security 1645 E. Roosevelt St.
Division of Business and Finance Phoenix, AZ 85006
Office of Procurement
1789 West Jefferson, Site Code 805Z
Phoenix, Arizona 85007
By: ____________________________ By: ___________________________________
Max Porter
Title: Chief Procurement Officer Title: Deputy Director____________________
Date: ___________________________ Date:

Arizona Refugee Resettlement Program – VISTA Project
(Sponsor Agency) Attachment A - VAD
(Assigned Agency)
Member Name: PSO Date:
Arizona Refugee Resettlement Program VISTA Project - Mission
The Arizona Refugee Resettlement Program (RRP) is partnering with the Corporation for National and Community Service (CNCS) to
develop the Arizona Refugee Resettlement VISTA Project (Project). The proposed five year Project’s goal is to provide opportunities
for non-profit agencies in Central and Southern Arizona to develop capacity building VISTA assignments that sustain and enhance
effective refugee resettlement and integration.
Agencies that partner with RRP in this Project shall become known as participating agencies, and shall develop VISTA assignments
that contribute to the effective resettlement of refugees and other eligible beneficiaries - including their achieving the goal of
economic self-sufficiency as quickly as possible after arrival in the United States, in accordance with Title IV, chapter 2, Sec. 411. (8
U.S.C. 1521) of the Immigration and Nationality Act (INA). To promote their effective resettlement and attainment of self-
sufficiency, refugees and other eligible beneficiaries, particularly those who are newly arrived in the United States and the recipients
of Refugee Cash Assistance (RCA) and Temporary Assistance for Needy Families (TANF), need specialized services that are directed
Project Year (First, Second, Third)

toward their securing employment as soon as possible after arrival in the United States.
Program Goals (Milestones)
Milestone #1: Increase Volunteer Participation that shall lead to refugees obtaining economic self-sufficiency.
Participating agencies shall report on the increase in resource development of their VISTA assignment by tracking the number of
refugees obtaining employment or receiving assistance or services that address barriers to economic self-sufficiency. Participating
agencies shall also track the number of volunteers participating in the assignment and the total number of volunteer service hours
provided by each volunteer. During Year Five of the grant, 335 volunteers shall participate in economic self-sufficiency programs for
refugees, with those volunteers providing a combined total of 4,500 volunteer services hours. More than 1,500 refugees shall
receive assistance or services through the VISTA assignments, with a corresponding 45 refugees projected to secure employment.
Milestone # 2: Increase Donations
Participating agencies shall realize an increase in both cash and in-kind resources to support existing and new programming that
serve refugees in efforts to attain economic self-sufficiency. During Year Five of the Project, cash resources shall increase to $4,500
and in-kind resources shall increase to $215,000. The donations shall be linked to programs that support employability services and
other services that address barriers to employment - as noted above.
Milestone #3: Design, Develop & Implement Programs
Programs are designed, developed and implemented that provide services to refugees and are linked to programs that support
employability services and other services that address barriers to employment. Participating agencies shall report on the increase of
program development of their VISTA assignment by tracking the numbers of refugees who secure employment or receive assistance
or services. More than 1,500 refugees shall receive assistance or services through the VISTA assignments and a corresponding 45
refugees are projected to secure employment.
Assigned Agency
Mission
VISTA assignment goal
(clearly state how this goal supports the goals of employment, social services or adjustment services of the federally funded Refugee Resettlement Program.)
How shall this VISTA assignment contribute to the goal of economic How shall you measure the impact?
self-sufficiency
1 VISTA Assignment Description
Arizona Refugee Resettlement Program – VISTA Project
(Sponsor Agency)
Objective 1: Timeline:
Activities:
Goals or expected results: Measurement:
Links to overall project milestones:
Objective 2: Timeline:
Activities:

Goals or expected results: Measurement:
Links to overall project milestones:
Objective 3: Timeline:
Activities:
Goals or expected results: Measurement:
Links to overall project milestones:
Objective 4: Timeline:
Activities:
Goals or expected results: Measurement:
Links to overall project milestones:
Objective 5: Timeline:
Activities:
Goals or expected results: Measurement:
Links to overall project milestones:
2 VISTA Assignment Description
Arizona Refugee Resettlement Program – VISTA Project
(Sponsor Agency)
Objective 5: Timeline:
Activities:
Goals or expected results: Measurement:
Links to overall project milestones:
Objective 6: Timeline:

Activities:
Goals or expected results: Measurement:
Links to overall project milestones:
3 VISTA Assignment Description

Attachment B
Arizona Refugee Resettlement AmeriCorps*VISTA Project
June 16, 2013 - June 28, 2014
PROJECT PLAN
Summary
The Arizona Refugee Resettlement Program (RRP) is partnering with the Corporation for National
and Community Service (CNCS) to develop the Arizona Refugee Resettlement VISTA Project
(Project). The goal of the Project is to provide opportunities for non-profit agencies in Central and
Southern Arizona to develop capacity building VISTA assignments that sustain and enhance effective
refugee resettlement and integration.
Agencies that partner with RRP in this Project are known as participating agencies, and shall develop
VISTA assignments that contribute to the effective resettlement of refugees and other eligible
beneficiaries - including their achieving the goal of economic self-sufficiency as quickly as possible
after arrival in the United States (U.S.), in accordance with Title IV, Chapter 2, Sec. 411. (8 U.S.C.
1521) of the Immigration and Nationality Act (INA). To promote their effective resettlement and
attainment of self-sufficiency, refugees and other eligible beneficiaries, particularly those who are
newly arrived in the U.S. and the recipients of Refugee Cash Assistance (RCA) and Temporary
Assistance for Needy Families (TANF), need specialized services that are directed toward their
securing employment as soon as possible after arrival in the U.S.
It is essential that refugees and other eligible beneficiaries receive a holistic and seamless delivery of
linguistically relevant and culturally appropriate services that best help them integrate into their new
home and attain economic self-sufficiency. Participating agencies shall engage refugees as they plan,
develop, implement and evaluate the VISTA assignments. Participating agencies shall develop
assignments for capacity building programs that support the following refugee resettlement service
areas: employment and case management, English Language Training (ELT), medical services, and
assignments that build linkages to related supportive services, such as childcare and transportation.
VISTA assignments may also be developed to support specific RRP discretionary programs, such as
services to older refugees, K-12 refugee school impact, and preventive and behavioral health service
programs.
Assignments shall focus on the CNCS key anti-poverty principles of economic development,
educational development and healthy futures. The Project shall provide both free and cost-share
VISTA member resources to approximately 20 participating agencies that provide refugee-specific
services in the areas of Resource Development and Strategic Planning and Program Design.
Resource Development
Goal Statement: The resource development goal for Year Five is to increase the number of
volunteers, the number of service hours, and the in-kind and cash resources that can be directly
linked to refugees obtaining self-sufficiency or employment by ten percent. Resource development

shall include volunteer recruitment and fundraising for programs with an end goal of providing
assistance to refugees that shall lead to economic self-sufficiency.
Milestone #1: Increase Volunteer Participation that shall lead to refugees obtaining economic
self-sufficiency.
Participating agencies shall report on the increase in resource development of their VISTA
assignment by tracking the number of refugees obtaining employment or receiving assistance or
services that address barriers to economic self-sufficiency. Participating agencies shall also track the
number of volunteers participating in the assignment and the total number of volunteer service hours
provided by each volunteer. During Year Five of the grant, 335 volunteers shall participate in
economic self-sufficiency programs for refugees, with those volunteers providing a combined total of
4,500 volunteer services hours. More than 1,500 refugees shall receive assistance or services
through the VISTA assignments, with a corresponding 45 refugees projected to secure employment.
Milestone # 2: Increase Donations
Participating agencies shall realize an increase in both cash and in-kind resources to support existing
and new programming that serve refugees in efforts to attain economic self-sufficiency. During Year
Five of the Project, cash resources shall increase to $4,500 and in-kind resources shall increase to
$215,000. The donations shall be linked to programs that support employability services and other
services that address barriers to employment - as noted above.
Strategic Planning and Program Design
Goal Statement: The Project shall strengthen the capacity of public and private non-profit agencies
to deliver services that encourage and support refugees’ economic self-sufficiency. These efforts
shall include new or expanded existing programs that focus on the CNCS key anti-poverty principles
of economic development, educational development and healthy futures.
Milestone #1: Design, Develop & Implement Programs
Programs are designed, developed, and implemented that provide services to refugees and are
linked to programs that support employability services and other services that address barriers to
employment. Participating agencies shall report on the increase of program development of their
VISTA assignment by tracking the numbers of refugees who secure employment, receive assistance,
or services. More than 1,500 refugees shall receive assistance or services through the VISTA
assignments and a corresponding 45 refugees are projected to secure employment.

Attachment C
BUDGET - STANDARD
1) VOLUNTEER SUPPORT EXPENSES
GRANTEE PERSONNEL (1) (2) (3) (4) (5) (6)
EXPENSES Annual % Time Spent Total Cost Federal Funds Non-Federal Member
Position Title Salary on Project Requested Funds Support
(cash grant) Requested (non cash)
TOTAL PERSONNEL EXPENSES 0
a. FRINGE BENEFITS 0
b. (1) GRANTEE STAFF LOCAL TRAVEL 0
(2)GRANTEE STAFF LONG DISTANCE TRAVEL 0
c. EQUIPMENT 0
d. SUPPLIES 0
e. CONTRACTUAL SERVICE 0
f. OTHER 0
Communication 0
Printing 0
Logistics 0
g. INDIRECT COSTS 0
TOTAL VOLUNTEER SUPPORT EXPENSES 0
2) VOLUNTEER EXPENSES
a. PERSONNEL EXPENSES 0
Fingerprint Cost 0
b. TRAVEL 0
Reimbursement 0
c. TRAINING OR CONFERENCES 0
Registration 0
d. OTHER: 0
Cost Share (if named Subrecipient) 0
TOTAL VOLUNTEER EXPENSES $ $ $ $
TOTAL COST $ $ $ $
PERCENTAGES % % % %
Corporation Form 424-AA (5/04) Modified SF 424A (5/04)
ACY-1288A FORFF (8-12)

ARIZONA DEPARTMENT OF ECONOMIC SECURITY
Attachment D Administration for Children, Youth and Families
REQUEST FOR SEARCH
OF
CENTRAL REGISTRY FOR BACKGROUND
CHECK
This document and any files transmitted with it are confidential and intended solely for the use of the individual or entity to
which they are addressed. If you have received this information in error, please notify the sender and destroy the information. The
information contained in the Arizona Department of Economic Security, Child Protective Services (CPS) Central Registry and
any attached files shall be used as a factor to determine qualifications for individuals applying for contracts with this state,
including employees of the prospective contractor, contractors, and subcontractors for positions that provide direct services to
children or vulnerable adults. The information contained in the Central Registry for Background Check and any attached
files is confidential and shall not be further disseminated or shared.
PLEASE FILL OUT THE INFORMATION BELOW. All fields must be completed, accurately and
legibly.
Offeror, Contractor, or Subcontractor Name (Print/Type)
Solicitation Number: Contract Number: ADES
ADES
Tracking # (You must provide your unique tracking number. This Check One:
number will be used to identify and track this document and the
New
individuals linked to it.):
Extension
Phone Number
Mailing Address Email Address
Name of Person Authorized to Submit Request (Print/Type)
Requester’s Signature Date of Request
DES Division: Division of Aging and Adult Services Division Contact Person: +DAAS CR
SUBMIT YOUR COMPLETED CENTRAL REGISTRY REQUEST THROUGH ONE OF THE FOLLOWING
METHODS: Mail to:
DCYF Contracts Unit
Attention: CENTRAL REGISTRY
REQUEST Arizona Department of
Economic Security
1789 W. Jefferson Street, SITE CODE
940A Phoenix, AZ 85007
Fax to: CENTRAL REGISTRY REQUEST at 602-542-3330
Email (encrypted) to DCYFCentralRegistryCheck@azdes.gov
RESULTS of this check will be:
1. EMAILED to the address above indicating that one or more individuals on the request was (were) unable to be processed with
the information provided; or
2. EMAILED to the address above if all names are cleared; or
3. EMAILED to the address above with information on individuals who are found to have substantiated reports; and

4. MAILED to the individual who is found to have a substantiated report.
Internal Use Only:
For Solicitations Only: DES Designated Staff (Office of Procurement):
For Contracts: Notify DES Designated Staff (Program):
See last page for EOE/ADA/LEP/GINA disclosures
REQUEST FOR SEARCH OF CENTRAL REGISTRY FOR BACKGROUND
CHECK
(All fields must be completed, accurately and
legibly.)
INDIVIDUAL’S INFORMATION
NAME ALIAS (Previously used name(s))
SOC. SEC. NO. DATE OF BIRTH
ADDRESS (No., Street, City, State, ZIP)
DES – INTERNAL USE ONLY (Search results)
Reports: Yes Number: [See attached document(s)] No Date of Search:
NAME OF PERSON COMPLETING SEARCH SIGNATURE
INDIVIDUAL’S INFORMATION
NAME ALIAS (Previously used name(s))
SOC. SEC. NO. DATE OF BIRTH
ADDRESS (No., Street, City, State, ZIP)
DES – INTERNAL USE ONLY (Search results)
Reports: Yes Number: [See attached document(s)] No Date of Search:
NAME OF PERSON COMPLETING SEARCH SIGNATURE
INDIVIDUAL’S INFORMATION
NAME ALIAS (Previously used name(s))
SOC. SEC. NO. DATE OF BIRTH
ADDRESS (No., Street, City, State, ZIP)
DES – INTERNAL USE ONLY (Search results)
Reports: Yes Number: [See attached document(s)] No Date of Search:
NAME OF PERSON COMPLETING SEARCH SIGNATURE
INDIVIDUAL’S INFORMATION

NAME ALIAS (Previously used name(s))
SOC. SEC. NO. DATE OF BIRTH
ADDRESS (No., Street, City, State, ZIP)
DES – INTERNAL USE ONLY (Search results)
Reports: Yes Number: [See attached document(s)] No Date of Search:
NAME OF PERSON COMPLETING SEARCH SIGNATURE

DISQUALIFICATION ACTS
A person is disqualified from providing services to DES clients in a direct service position if he/she is identified as the subject of the
substantiated report for any of the following.
24 Child death due to alleged abuse or neglect, or suspicious death
25 Injuries requiring emergency medical treatment
27 Child age 24 months is shaken (shaken baby syndrome)
33 Untreated life threatening condition, Infant Doe, Non-organic FTT
37 Imminent harm to child under the age of six (6) due to lack of supervision by parent/caretaker
38 Neglect results in injury/illness requiring emergency medical treatment
39 Imminent harm to child due to health or safety hazards in living environment/exposure to the elements
40 Child diagnosed as suicidal by mental health professions, parent refused to allow treatment
41 Physical evidence of sexual abuse reported by a medical doctor or child reporting sexual abuse within the past seven days
42 Child reporting vaginal or anal penetration or oral sexual contact within past 72 hours and has not been examined
43 Abandoned, no parent willing to provide immediate care for a child and child is with a caregiver unable or unwilling to provide care now
45 Injuries may require medical treatment
46 P3 Injury to child under age six years
50 Living environment presents health or safety hazards to a child under the age of six
51 Sexual conduct/physical injury between children due to inadequate supervision
54 Sexual behavior within the past 8-14 days
55 Child diagnosed by mental health professional with behavior consistent with emotional abuse
56 Abandoned, no parent willing to care for a child, child with caretaker unable or unwilling to care for child less than one week
66 Significant developmental delays due to neglect
69 Attempted sexual behavior or sexual behavior, 14 days to three years r last occur unknown
72 Parent, guardian or custodian suggests or entices child to engage in sexual behavior, no touching
76 Use of child by parent, guardian or custodian for material gain
82 Parent, guardian or custodian sexually abused a child in past, now in home with a child
83 Attempted sexual behavior or sexual behavioral when last occurred more than three years
101 Death of a child due to neglect
111 Death of a child due to physical abuse or suspicious death
201 Physical abuse high risk
202 Physical abuse moderate risk
301 Neglect, high risk
302 Neglect, moderate risk
401 Sexual abuse, high risk
402 Sexual abuse, moderate risk
403 Sexual Abuse, low risk
404 Sexual Abuse, response 4
501 Emotion Abuse, high risk
502 Emotional abuse, moderate risk

Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the
Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of
1975, and Title II of the Genetic Information Nondiscrimination Act (GINA) of 2008; the Department prohibits discrimination in
admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, disability,
genetics and retaliation. The Department must make a reasonable accommodation to allow a person with a disability to take part in
a program, service or activity. For example, this means if necessary, the Department must provide sign language interpreters for
people who are deaf, a wheelchair accessible location, or enlarged print materials. It also means that the Department will take any
other reasonable action that allows you to take part in and understand a program or activity, including making reasonable changes
to an activity. If you believe that you will not be able to understand or take part in a program or activity because of your disability,
please let us know of your disability needs in advance if at all possible. To request this document in alternative format or for further
information about this policy, contact your local office; TTY/TDD Services: 7-1-1. • Free language assistance for DES services is
available upon request.