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

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* 1. Please enter your contact information:

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* 2. Upload CV here

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

Proposal Submission Plans

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

Panel Experience

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

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

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* 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)

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

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

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* 10. Your Primary Discipline:

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

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* 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)

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* 14. GENDER

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* 15. ETHNICITY:

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* 16. RACE (check one or more)

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.

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