ANA Panel Reviewer Profile Questionnaire (Previously approved, ongoing collection)

ANA Panel Reviewer Profile Questionnaire - 2017
THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)
Public reporting burden for this collection of information is estimated to average .50 hours per response, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid
OMB control number.
The Administration for Native Americans (ANA) annually conducts objective panel reviews for applications received in response to funding
opportunity announcements (FOA). Historically, panel review sessions are held between April and June preceded by panel review training. A
significant amount of time (estimated 8-10 hours) is required to read and score each application using a predetermined scoring criterion provided in
the FOA. Panel reviews are composed of three reviewers and a facilitator (or chair). ANA is authorized to provide reviewers and facilitators
honorarium in exchange for full participation in all required panel review activities.
Reviewers are responsible for submitting to the facilitator an evaluation of each application, providing written comments and scores based on the
FOA evaluation criteria. Additionally, reviewers are required to fully participate in all scheduled telephone discussions of applications. Facilitators
coordinate the panel discussions and draft a Panel Summary Report (PSR) which accurately reflects panel discussion, reviewer comments, and
scores for each application.
If you are interested in becoming a reviewer or facilitator, please complete the questionnaire below. If you have reviewed for ANA in the past three
years, please complete Section I only unless your information has changed. If you are new to the ANA panel review process, please complete
Sections I and II. If you have questions or need assistance, contact the ANA Help Desk at 1-877-922-9262.

To apply, please complete this form and attach it, along with your resume, to an e-mail and send to ANAReviewer@acf.hhs.gov.
You will receive a confirmation that your application has been received

SECTION I: to be completed annually by all applicants
Please indicate your availability for each session (These dates are tentative and subject to change):

Session 1 - Program Area: P&M, EMI, ILEAD

Dates: 5/12-5/25, 2017

Session 2 - Program Area: ERE, SEDS, SEDS-AK

Dates: 6/2-6/26, 2017

Did someone refer you to apply to be an ANA Panel Reviewer?

Yes

No

Who?

Contact Information
Title:

Last Name:

First Name:

ANA Reviewer Number (Internal Use Only):

Middle Initial:

Have you served as a reviewer for ANA using a different last name?

Yes

No

Preferred Mailing Address:
Street:
City:

Expiration Date: 06/30/2018

State:

Have you ever served as a reviewer for ANA using
a different mailing address?
Yes
No

ZIP:

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Employer:
Position Title:

You will be required to participate in sometimes lengthy conference calls for training and panel discussions. Does your preferred
contact number provide you ample opportunity and time, i.e. not limited to a predetermined amount of mobile minutes?
Yes

No

Primary Contact Number:
Primary Email:

Secondary Contact Number:
Secondary Email:

Do you have access to reliable, consistent internet connection (required
to use the online application review module)?
Yes

No

The Administration for Children and Families, U. S. Department of Health and Human Services is committed to increasing the diversity of the
non-federal peer reviewers utilized in the competitive grants review process. In order to achieve this goal, we are requesting that you
voluntarily indicate your race and/or ethnic heritage on the self-identification section by checking the appropriate boxes on the reviewer
application form. Please note that this section utilizes the standard Federal identification categories. Your assistance is invaluable in enabling
the agency to promote broad representation, especially for underserved and underrepresented groups and track our progress on this
important goal.
Race/Ethnic Heritage (Please check appropriate boxes)
African American/Black
American Indian/Alaska Native
Asian
Hispanic/Latino
Native Hawaiian/Other Pacific Islander
White/Caucasian

Do you affiliate yourself with a certain tribe or native community?

Yes

No

If yes, which?
Have you worked with any Tribes or organizations in the last 36 months that would cause you
to have a conflict of interest if you were assigned their application?

Yes

No

Please list the Tribe(s) and/or Organization(s)
Grant Reviewing Experience (select all that apply)
Experienced ANA reviewer............................ Which years:
Experienced Federal reviewer....................... Agency:
Experienced Non-Federal reviewer............... Organization:
Limited/No reviewer experience

Are you interested in being a Chairperson? (job description can be found on ANA website)
Have you served as a Chairperson with ANA in the past?
Expiration Date: 06/30/2018

Yes
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Yes

No

No
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SECTION II: to be completed by new applicants only
Area of Experience

Primary

Secondary

Tertiary

Social Development Strategies
Economic Development Strategies
Sustainable Employment Strategies
Environmental Regulatory Enhancement
Native Languages: Immersion Programs
Native Languages: Preservation and Maintenance
Youth

What is your experience working with American Indians, Alaska Natives, Native Hawaiians, and/or Pacific Islanders? (up to 300 words)

Please provide a brief narrative describing your professional experience/expertise in the topic(s) you selected below (up to 300 words,
please do not copy and paste your resume).

Expiration Date: 06/30/2018

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Professional Expertise (select all that apply)
Agricultural Enterprise

Infrastructure

Arts and Culture

IT Systems

Asset Building

Job Training

Budgeting and Finance

Local Sourcing and Technology

Career Pathways

Native American Language Nests

Commercial Trade

Native American Language Restoration Programs

Community Development

Native American Language Survival Schools

Community Development Financial Institutions (CDFI)

Native Language Project/Program Management

Community Environmental Programming

Native Language Teaching

Community Health

Nutrition and Fitness

Compilation, Transcription and/or Analysis of Oral Testimony

Organizational Development

Cultural Programs

Partnerships

Development of Teaching Materials for Native Languages

Place-based Strategies

Early Childhood Development

Professional Development

Economic Competitiveness

Responsible Fatherhood

Economic Development

Safety and Security

Economic Infrastructure

Strengthening Families

Economic Stability

Subsistence

Entrepreneurship and Microbusiness

Suicide Prevention

Environment Regulation

Sustainability

Environmental laws, regulations and ordinances

Training and/or Technical Assistance in Native Languages

Environmental Training and Technical Assistance

Tribal Codes and Laws

Faith Based and Community Approaches

Tribal Environmental Codes and Laws

Financial Literacy

Tribal Government/Governance

Geographic Information Systems

Two-Spirit/LGBT

Human Trafficking

Youth Development

Expiration Date: 06/30/2018

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Writing Sample
Please read the Evaluation Criteria: Need for Assistance and the excerpt from a sample application below. In the space provided,
please draft a response detailing strengths and weaknesses of the application based upon the information provided in the excerpt.
Evaluation Criteria: Need for Assistance
To evaluate the Need for Assistance, reviewers will consider the extent to which the application includes:
A.
B.
C.
D.

Concise problem statement that identifies the current condition(s) to be addressed by the project.
Supporting information or data detailing the scope and nature of the problem.
Current challenges standing in the way of addressing the problem.
A clear description of the community to be served and who the intended beneficiaries are.

Sample Application Excerpt
The problem or issues faced by the AUIC are varied but all revolve around one theme - the AUIC has been working for years to provide
services that meet the unique needs of our native community but infrastructure weaknesses, including staffing shortages, board
member professional development, policy and procedure development, community outreach and the development and implementation
of additional services have all been hampered by the fact that the AUIC does not have a strategic plan or an infrastructure to implement
a strategic. Instead, the AUIC focus has been to pursue money where it is available and provide some services in order to keep the
doors open. However, this has been done without involving the community in determining the most pressing priorities. This disconnect
often times leaves the most pressing problems unresolved. The problem statement is twofold in that to truly build capacity within a
small Native Urban organization you must have a multi-pronged approach to build that capacity. Because of the tough economic time
faced by all Americans, especially Native Americans, and the severe lack of discretionary funds to meet these needs any organization
must address these problems in a holistic manner. We have identified two interrelated problems that have created our inability to meet
our community needs.
Our Problem Statement is: (1) The staff and Board have never had the opportunity or funds to be trained in organizational management
skills necessary to govern and manage a growing non-profit organization and (2) Native Americans within the Aniwer district are not
utilizing the social service providers within Aniwer to meet their current needs and to assist in the process of becoming self-sufficient
because of a perceived lack of cultural awareness among the social service providers.

Expiration Date: 06/30/2018

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