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Peer Reviewer Application

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First Name:
Last Name:
Work/Community 
Affiliation:
Address:
Suite/Apt:
City:
State:   Zip:
Daytime Phone:  ext. 
Evening Phone:  ext. 
Mobile Phone:
Fax:
E-Mail Address:
 
Orientation Sessions are required for all peer reviewers. Proposal will be distributed at Session. Please select one of the following dates:
Thursday, April 3, 2009
10:00 a.m. - 12:00 noon		     Thursday, April 3, 2009
5:30 p.m. to 7:30 p.m.
 
To avoid conflicts of interest, please list any not-for-profit agency where you or a family member are employed, serves on the governing board, or receive contracts, and or services.:
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Do you have experience in one of more of the following areas:
National Service
Volunteer Management
Education
Literacy
Tutoring
Human Services
Non-profit Management
Substance Abuse
 HIV/AIDS
Public Safety
Counseling
Mentoring
Recreation
Mental Health
Abuse/Neglect
Physical/developmental Disability
 
PEER REVIEW PANEL SCHEDULE
Please indicate the panel(s) you prefer to attend.
You may select more than one (1) panel session.
Not to exceed three (3).
DateTimeFunding Initiative
April 22nd10:00-NoonSuccess By 6
April 23rd5:30-7:30pmSuccess By 6
April 24th10:00-NoonHIV/AIDS
April 24th5:30-7:30pmHIV/AIDS
April 29th10:00-NoonFamily Power
April 30th5:30-7:30pmFamily Power
May 6th10:00-NoonBridges To Success
May 7th5:30-7:30pmBridges To Success
May 8th10:00-NoonBridges To Success
May 8th5:30-7:30pmBridges To Success