SAE Consulting Experts Form

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* 1. Contact Information

Name

Company

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Short Introductory Letter - How Do You Introduce Yourself?

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* 3. Most recent CV/Resume

Please upload a PDF, DOC or DOCX file that clearly reflects your areas of expertise.

PDF, DOC, DOCX file types only.

Choose File

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* 4. Short Bio

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* 5. Title or Titles, in Preferred Order

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* 6. Preferred Pronouns

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* 7. Level Of Education

Bachelors

Masters

Associates

Doctorate

Other?

Other (please specify)

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* 8. Years Of Consulting Experience

0-5

6-10

11-15

16-20

21-25

26 and over

Do you have other related experience: clinical or research or otherwise?

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* 9. Types Of Consulting Experience

Training

Technical Assistance

Executive Management

Outsourcing C-Suite Responsibilities

Creation of Manuals, Workbooks, White Papers, Peer Review, Outcome Reports

Licensing

Grant Writing

Grant Reviewing

Program Evaluation

Parity Compliance

Fiscal Sustainability Consulting

Revenue Cycle Management

Establishment of PPS Rates

Health Information Technology (including AI)

Data Analytics

EHR Implementation

CARF

JCAHO

Six Sigma Performance Improvement

Legal Expertise

Other (please specify)

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* 10. Populations Of Focus (Clinical and Organizational Expertise)

	Mental Health	Substance Use	Integrated Care	Other
Children	Children Mental Health	Children Substance Use	Children Integrated Care	Children Other
Adolescents	Adolescents Mental Health	Adolescents Substance Use	Adolescents Integrated Care	Adolescents Other
Adults	Adults Mental Health	Adults Substance Use	Adults Integrated Care	Adults Other
Seniors	Seniors Mental Health	Seniors Substance Use	Seniors Integrated Care	Seniors Other
Black, Indigenous, and People of Color (BIPOC)	Black, Indigenous, and People of Color (BIPOC) Mental Health	Black, Indigenous, and People of Color (BIPOC) Substance Use	Black, Indigenous, and People of Color (BIPOC) Integrated Care	Black, Indigenous, and People of Color (BIPOC) Other
People Experiencing Homelessness	People Experiencing Homelessness Mental Health	People Experiencing Homelessness Substance Use	People Experiencing Homelessness Integrated Care	People Experiencing Homelessness Other
Veterans	Veterans Mental Health	Veterans Substance Use	Veterans Integrated Care	Veterans Other
People Living with HIV / AIDS Diagnosis	People Living with HIV / AIDS Diagnosis Mental Health	People Living with HIV / AIDS Diagnosis Substance Use	People Living with HIV / AIDS Diagnosis Integrated Care	People Living with HIV / AIDS Diagnosis Other
LGBTQIA+	LGBTQIA+ Mental Health	LGBTQIA+ Substance Use	LGBTQIA+ Integrated Care	LGBTQIA+ Other
Transgender and Other Gender Minority Identities	Transgender and Other Gender Minority Identities Mental Health	Transgender and Other Gender Minority Identities Substance Use	Transgender and Other Gender Minority Identities Integrated Care	Transgender and Other Gender Minority Identities Other

Other (please specify)

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* 11. Consulting Settings

Federally Qualified Health Center (FQHC)

Hospital

Primary Care Clinic

Certified Community Behavioral Health Clinic (CCBHC)

Community Mental Health Centers (CMHC)

Community-based Substance Use Treatment Facility or Agency

School

State Agency

Managed Care Organization

Center for Medicaid & Medicare (CMS)

Frontier Organization

Rural Organization

Suburban

Urban

Indigenous or Tribal Setting

Other (please specify)

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* 12. Please Check your Experience with the Following Agencies

SAMHSA - Substance Abuse and Mental Health Services Administration

HRSA - Health Resources and Services Administration

CDC - Centers for Disease Control and Prevention

ACF — Administration for Children and Families

ACYF - Administration on Children, Youth, and Families

DOJ - Department of Justice

DOC - Department of Commerce

OMH - State Office Of Mental Health

Health Plans

AG - Attorneys General

IG - Inspectors General

Other (please specify)

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* 13. Have you provided consulting expertise as an independent contractor outside of an employment relationship?

Yes

Other (please specify)

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* 14. Example 1: Please upload an example (PDF, DOC, or DOCX) of de-identified evidence of expertise in areas identified on this form.

Examples can include grant proposals, evaluation plans, evaluation reports, publications, white papers, and consulting reports reflecting achievement of goals and objectives.

Alternatively, if you utilize an online or cloud portfolio, feel free to upload a document with clickable links.

PDF, DOC, DOCX file types only.

Choose File

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* 15. Upload Example Option #2: A PDF, DOC, or DOCX of de-identified evidence of expertise in areas identified on this form.

PDF, DOC, DOCX file types only.

Choose File

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* 16. Upload Example Option #3: A PDF, DOC, or DOCX of de-identified evidence of expertise in areas identified on this form.

PDF, DOC, DOCX file types only.

Choose File

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* 17. Is there anything you'd like SAE to know more about in terms of who you are?

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* 18. We appreciate your feedback, as all of it is useful information. You may have other suggestions or questions you feel would be useful. We'd love to hear them. Thank you for your time and thoughtfulness in completing this form.