Volunteer Questionnaire

OMB NO.: 0524-0041

Dear volunteer,

Thank you for volunteering your service to USDA National Institute of Food and Agriculture (NIFA) and your community. Please take time to provide your information below as it will assist NIFA in identifying panelists and ensuring our peer review panels have the required expertise while being representative and diverse. The information you provide will be used by NIFA in selecting reviewers for grant applications submitted to NIFA programs. In addition, the contact information may be used to update records pertaining to active NIFA grant applications and grants. This information will not be used for any other purpose.

An asterisk (*) indicates a required field.

Name basic details

Prefix:

* First Name:

Middle Name:

* Last Name:

Suffix:

* E-mail address:

* Phone number:

(e.g. 202-456-1414)

* Race:

* Ethnicity:

* Gender:

* Military experience:

Degree What is the highest degree you have earned?
In what field?

General expertise

What is your primary expertise?

Detailed expertise

Please provide some key words describing your specific expertise, e.g., scientific disciplines, courses taught, species/topics studied (such as sheep, red pine, potatoes, nitrogen oxides, fruit, forest soils):

* Research/Education/Extension/Other appointment. Please classify the proportion of the function of your work: [term definitions]

Research

Research %

Education

Education %

Type*

* ^{On some browsers, it may be necessary to hold down either the CONTROL, APPLE,
or SHIFT key to select multiple items}

Extension

Extension %

Other

Other %

Organization

* Organization: Your Organization:

Please choose from the list, or add your organization below if it is not on the list.

Department:

Rank:

Additional Organization Information:

Mail Stop:

Fax number:

Street Address:

* City:

State:
**If Province Enter After City

* Zip or Postal Code:

* Country:

Mailing info
Address for delivery by courier if different

Street Address:

City:

State:
**If Province Enter After City

Zip or Postal Code:

Country:

URL of personal Web page:

(e.g. http://www.yourpage.esu.edu)

Are you willing to provide written reviews of USDA/NIFA grant applications? Yes or No.

Yes

When? (Choose all that apply)

Fall 2023

Winter 2024

Spring 2024

Summer 2024

Fall 2024

If you are not available now, would you be willing to review for USDA/NIFA in the future?

Privacy information: The information you provide will be used by NIFA in selecting reviewers for grant applications submitted to NIFA programs. In addition, the contact information may be used to update records pertaining to active NIFA grant applications and grants. This information will not be used for any other purpose.

Paperwork Reduction Act information: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0524-0041. The time required to complete this information collection is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.