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CVAD Peer Reviewer Application for Competitive Grant Applications
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Indicates a required field
First Name:
*
Last Name:
*
Address:
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City:
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State:
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Cell Phone Number:
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Other Phone Number:
Email:
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Organization/Employer:
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Age Range:
*
18-26
27-54
55+
Which of the following do you identify with:
*
African American
Alaska Native/American Indian
Asian
White (not of Hispanic origin)
Native American or Other Pacific Islander
Hispanic
Authorized Submission Number:
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Please select the term(s) with which you most identify with:
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Male
Female
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I prefer not to say
Please Specify:
Are you fluent (speaking reading, writing) in any languages other than English?:
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Yes
No
Please specify which languages you are fluent:
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Education:
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HS Diploma/HiSET/GED
Associates
Bachelor's
Masters
PhD
M.D.
Professional License(s) or Certifications - List all that apply:
*
(Mental Health, Substance Use Disorders, Etc.)
Grant Reviewer Experience:
*
No grant reviewing experience
Experienced Local Grant/Foundation reviewer
Experienced State Grant reviewer
Experienced Federal Grant reviewer
Describe the types of grants you have reviewed in the past:
*
Are you a victim/survivor of a crime?:
*
Yes
No
Prefer not to say
What type of crime were you a victim of?:
*
How long ago was your victimization(s)?:
*
Within the last 12 months
1-3 years ago
4-10 years ago
10+ years ago
Were there multiple victimizations or victimization over a period of time?:
*
Did you receive services from a program in Iowa? If yes, please explain:
*
Please select all categories for which you are interested in reviewing grants:
*
Domestic Abuse Comprehensive Services
Sexual Abuse Comprehensive Services
Shelter Based Services
Culturally Specific Domestic Violence & Sexual Assault Comprehensive Services
Homicide Survivor Comprehensive Services
Human Trafficking Comprehensive Services
Mental Health Services (Traditional & Alternative Healing options)
Legal Services
Law Enforcement response to victims of crime
Violence Against Women Prosecutors
Substance Abuse Services
Services for Older Iowans who’ve experienced victimization
Services for Youth/Children
Court projects
Services for Refugees & Immigrants
Services for Black, Indigenous and other People of Color (BIPOC)
Services for Men/Boys
Medical services (Child Advocacy Centers, Mobile Forensic Exams, etc.)
Services for LGBTQIA+ Individuals
Resume/Vitae:
*
Accepted Formats
: PDFs
Bio:
*
limit: 1,000 characters
Please list any programs/projects where you know you have a conflict and cannot review an application submitted by the entity:
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