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OMB NO.: 0524-0041
EXPIRATION DATE: 08/31/2022

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.
1. 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:
2. What is the highest degree you have earned?

In what field?
3. What is your primary expertise?
4. 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):
5. * 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 %
6. Organization
* 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:
7. 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)
8. Are you willing to provide written reviews of USDA/NIFA grant applications? Yes or No.
Yes When? (Choose all that apply)
Summer 2021
Fall 2021
Winter 2022
Spring 2022
Summer 2022
No 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.