Thank you for your interest in the Education Innovation and Research (EIR) Program. Please complete the questions below. Information gathered will not be shared publicly. It is collected to ensure a fair and competitive application review process, by enabling program staff to identify potential peer reviewer conflicts of interest or other factors that might affect objectivity.

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* 1. First Name

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* 2. Last Name

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* 3. Email address

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* 4. Do you have a financial interest in any application submitted in this competition? For instance, will you or your spouse receive a salary from an applicant if the application is funded?

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* 5. Have you been offered an opportunity to serve as an employee or consultant, advisor or contractor under one of the proposals submitted in this competition? For instance, has an applicant indicated interest in your consulting or other services if the application is funded?

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* 6. Did you help prepare, provide comments or otherwise review any application or portion of any application (in draft or final form) in the competition, even if you were not compensated for doing so?

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* 7. Does your employer have an interest in the outcome of the competition, even if you will not benefit personally? For example, you work for a university in the history department and an individual from the education department has submitted a proposal.

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* 8. Does your spouse’s employer have an interest in the outcome of the competition?

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* 9. Do any of the following persons or organizations have a financial interest in the outcome of the competition? Select all that apply.

a. Your child. For instance, your son or daughter will receive compensation under a proposed project. b. A member of your household; for instance, a “significant other” or “spouse equivalent” with whom you live. c. Any relative with whom you have a close relationship; for instance, a first cousin, parent, or sibling. d. A business partner. e. A former employer – if you have left employment within the last 12 months. f. An organization or person with whom you are seeking employment. For example, you submitted an application for employment with X University last month and X University has submitted an application in the competition. g. Someone with whom you have an arrangement for employment. For example, you are on an unpaid leave of absence from a research center and that center has submitted an application in the competition. h. An organization for which you serve as a director, officer, or trustee. For example, you are on the Board of Directors for the ABC Research Study Center and the center has submitted an application in the competition. i. An entity for which you serve as an active volunteer or participant. For instance, you chair the membership committee of a professional association and that association has submitted an application in the competition. j. A professional associate with whom you are conducting research or other professional activities, or have done so within the last 12 months; for instance, your Ph.D. advisor, if you received your degree within the last 12 months. k. A personal relationship, the nature of which might cause a reasonable person with knowledge of the facts to question your impartiality. For instance, your fiancé, a close personal friend, or someone in your field of expertise with whom you are an open ally or antagonist has submitted an application in the competition.

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* 10. Have you written, published, or otherwise commented on or been connected to any specific teaching methodology, or significantly identified with any pedagogical or philosophical viewpoints associated with this competition? For example, have you published an article or book chapter, or have you been associated in a significant way with the topic of cooperative learning, if cooperative learning is a key viewpoint associated with this competition?

a) If the answer to question 10 is yes, please explain whether, in your estimation, your connection or significant identification discussed above, including any articles or publications you have authored, raise concerns or cause someone to question your capacity to provide a fair and objective review of applications in this competition. b) Please provide copies or electronic links to copies of your written and/or published works, and/or interviews and commentaries regarding the specific teaching methodology, or pedagogical or philosophical viewpoint you have been identified with that, in your estimation, might raise concerns or cause someone to question your capacity to provide a fair and objective review of applications in this competition.

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* 11. Are you aware of any other circumstances that might cause someone to question your impartiality in serving as a reviewer for this competition? For example, an individual has been proposed as a Project Director if an application is successful. You are currently involved in litigation with this individual arising from your employment five years ago.

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* 12. Will you be in the country (United States) and have access to a reliable internet connection from May 2 - May 31, 2017

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* 13. Will you be able to participate in a 90 minute orientation webinar?
Tentative: May 2, 2017 

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* 14. Are you available for a week of independent reading (May 3 - May 14, 2017), scoring, and providing comments for each application using the G5 review system?

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* 15. Are you available to participate in panel calls (May 15 - May 26, 2017) of conference calls to discuss application scores and comments, as well as a follow up time (May 27 - May 31, 2017) to finalize written comments?

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* 16. Reviewers will participate in a discussion of applications facilitated by Department staff. Identify your panel call time preferences.

  First Preference Second Preference Third Preference
8:30 am - 11:30 am EDT
11:30 am - 2:30 pm EDT
2:30 pm - 5:30 pm EDT

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