NSF’s Eddie Bernice Johnson INCLUDES Initiative Prospective Reviewer Interest Form

Please complete this form to express interest in serving on a virtual panel for the National Science Foundation (NSF) to review proposals for the agency-wide initiative, NSF Eddie Bernice Johnson INCLUDES (Inclusion across the Nation of Communities of Learners of Underrepresented Discoverers in Engineering and Science) Initiative, one of the NSF 10 Big Ideas. The vision of NSF Eddie Bernice Johnson INCLUDES Initiative is to catalyze the STEM enterprise to work collaboratively for inclusive change, resulting in a STEM workforce that reflects the population of the Nation.

The information requested is pursuant to the National Science Foundation Act of 1950, as amended. Disclosure of all information is entirely voluntary. The information you provide will assist us in creating panels to ensure a diversity of expertise and experiences. Other NSF programs requesting names of potential reviewers or specialists in particular fields may also be given information from this form. Except for these purposes, this information will not be disclosed except as part of statistical reports or in a form that would not allow the identification of individuals.

Except for these purposes, this information will not be disclosed except as part of statistical reports or in a form that would not allow the identification of individuals. OMB No. 3145-0058

Contact Information

Question Title

* 1. Please enter your contact information:

First Name *

Last Name *

Position Title *

Institution/Organization/Company *

State (Location of Organization) *

Department, Section or Other Unit *

Your Email Address *

Your Best Contact Phone Number *

URL for professional homepage or uploaded CV (required)

Question Title

* 2. Upload CV here

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 3. Your Institution/Organization/Company Type (Check all that apply)

K-12 School/District

2 Year College

4 Year College or University

Minority-Serving Institution

Science Center/Museum/Organization

For Profit Organization

Not for/Non- Profit Organization

Community-Based Organization

Professional Organization

Other (please specify)

Proposal Submission Plans

Question Title

* 4. Is your institution/organization/company planning to submit an INCLUDES Initiative proposal?

Not Sure

Yes (lead/collaborative institution on a proposal due by October 2022)

Yes (partner institution on a proposal due by October 2022)

Yes (lead/collaborative institution on a proposal due by October 2023)

Yes (partner institution on a proposal due by October 2023)

If Yes (other capacity) Please explain:

Panel Experience

Question Title

* 5. Have you served on a previous INCLUDES Initiative review panel? (Check all that apply)

Yes, for INCLUDES Initiative Design & Development Launch Pilot Proposals

Yes, for INCLUDES Initiative Alliance Proposals

Yes, for INCLUDES Initiative Conference Proposals

Yes, for INCLUDES Initiative Alliance or Coordination Hub Reverse Site Visit

Yes, other

Question Title

* 6. Have you previously served on any NSF proposal review panel?

Yes

If Yes, for which NSF programs have you served on a proposal review panel?

Question Title

* 7. Have you participated (as PI, Co-PI, researcher, mentor, reviewer) in any of the following NSF-funded large-scale alliances/centers/networks? (Check all that apply)

EPSCoR

Engineering Research Centers (ERC)

Science and Technology Centers (STC)

Louis Stokes Alliances for Minority Participation (LSAMP)

Broadening Participation in Computing (BPC) Alliance

Alliances for Graduate Education and the Professoriate (AGEP)

INCLUDES Alliance

No, I have not participated in any NSF-funded alliances/centers/networks.

Other (please specify)

Question Title

* 8. Have you participated (as PI, Co-PI, researcher, mentor, reviewer) in any large-scale alliances/centers/networks that were not NSF-funded?

Yes (In the comment box below, please identify the alliances/centers/networks)

No, I have not participated in any large-scale alliances/centers/networks that were not NSF-funded.

Comment (please specify)

Question Title

* 9. Do you have experience implementing and/or evaluating broadening participation or diversity initiatives?

Yes, implementing

Yes, evaluating

Yes, both

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* 10. Your Primary Discipline:

Biological Sciences (except medicine and other clinical fields)

Computer and Information Sciences

Engineering

Geosciences

Mathematical Sciences

Physical Sciences (including physics, chemistry, astronomy, and materials science)

Education (Science, Mathematics, Engineering)

Social/Behavioral/Economic Sciences

Other (please specify)

Question Title

* 11. Primary Research Expertise (check no more than two)

STEM Disciplinary Research (in comment box below, state the discipline)

Education Research

Social Science Research

Evaluation and Assessment (in comment box below, state if expertise is quantitative, qualitative or mixed methods)

Broadening Participation Research (in comment box below, state if K-12, higher education, or informal education)

Collective Impact (or other social innovation frameworks)

Comments

Question Title

* 12. What additional expertise or experience do you have that may be valuable for reviewing INCLUDES Initiative proposals?

Demographic Information

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* 13. DISABILITY STATUS (check one or more)

Hearing Impairment

Mobility/Orthopedic Impairment

Visual Impairment

None

Prefer to self-identify

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* 14. GENDER

Man

Woman

Nonbinary

Prefer to self-identify

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* 15. ETHNICITY:

Hispanic or Latino

Not Hispanic or Latino

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* 16. RACE (check one or more)

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Multiracial

Prefer to self-identify

Thank you for your interest in reviewing for the Eddie Bernice Johnson INCLUDES Initiative. Once we have received a full set of responses, we will select panelists based on availability and expertise.