NSF Form 428A OMB No. 3145-0058

This is a survey to determine your interest in and availability for serving on a review panel for the NSF Scholarships in Science, Technology, Engineering, and Mathematics (S-STEM) program in the Division of Undergraduate Education (DUE) at the National Science Foundation. Once we have your responses on file, we will attempt to assign you to a panel if your experience and interests match the needs of a particular panel. Thank you for your interest in the S-STEM program.

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* 1. Title/Salutation

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* 2. First Name

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* 3. Middle Initial

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* 4. Last Name

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* 5. Contact Information

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* 6. Institution/Organization (no abbreviations)

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* 7. Institution/Organization Context

Disclosure of the demographic information below is entirely voluntary. The purpose of this information is to assist in the identification of prospective panelists to review for S-STEM or DUE programs. Except for these purposes, this information will not be disclosed except as part of statistical reports or in a form that would not allow identification of individuals.

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* 8. Gender (Optional):

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* 9. Ethnicity (Optional):

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* 10. Race (Optional):

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* 11. Which dates are you available to serve on an April panel? This cycle, S-STEM panels will be scheduled over 2 days, either consecutively, or two days apart. Please answer with your current availability and select your disposition for in-person, virtual or ad-hoc panels, without worrying about fitting a pre-determined pattern. Once panels are set up and if you are selected as a reviewer, program officers will contact you again to reconfirm the final dates. (Check all that apply.)

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* 12. Which dates are you available to serve on a May panel? This cycle, S-STEM panels will be scheduled over 2 days, either consecutively, or two days apart. Please answer with your current availability and select your disposition for in-person, virtual or ad-hoc panels, without worrying about fitting a pre-determined pattern. Once panels are set up and if you are selected as a reviewer, program officers will contact you again to reconfirm the final dates. (Check all that apply.)

 
 12% of survey complete.
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