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Home | CVAD Peer Reviewer Application for Competitive Grant Applications

Apply to be a Grant Peer Reviewer

* Indicates a required field

First Name:

*

Last Name:

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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:

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18-26

27-54

55+

Which of the following do you identify with:

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African American

Alaska Native/American Indian

Asian

White (not of Hispanic origin)

Native American or Other Pacific Islander

Hispanic

Please select the term(s) with which you most identify with:

*

Male

Female

Non-Binary

Transgender

Genderqueer

Gender Non-Conforming

Agender

Intersex

Not Listed

I prefer not to say

Please Specify:

Are you fluent (speaking reading, writing) in any languages other than English?:

*

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:

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(Mental Health, Substance Use Disorders, Etc.)

Grant Reviewer Experience:

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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:

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Are you a victim/survivor of a crime?:

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Yes

No

Prefer not to say

What type of crime were you a victim of?:

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How long ago was your victimization(s)?:

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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?:

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Did you receive services from a program in Iowa? If yes, please explain:

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Please select all categories for which you are interested in reviewing grants:

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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:

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Accepted Formats: PDFs

Preferred Dog Color:

*

Bio:

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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:

*

grip-e-hp

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