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Note: Round Three Innovation Review Panel Members will not be able to submit any Round Three Innovation proposals or to participate in any aspect of planning or submitting a Round Three Innovation proposal by a group or organization.

Thank you for your interest in the Innovation Grants Review Panel. BHCS is accepting applications for the Innovation (INN) Review Panel. INN Review Panel Members will review and score INN Round Three grant applications and provide feedback to BHCS regarding INN proposals that show the most potential to address the BHCS Learning Questions and to develop strategies that will produce the BHCS Desired Outcome.

BHCS invites community partners to nominate (and self nominate) individuals to participate on the Innovation Review Panel for Round Three. We are looking for a diverse group of individuals who have had experience with the specific target populations:
• Isolated Adults and Older Adults Consumers with serious mental illness
• Lesbian, Gay, Bisexual, Transgender, Questioning, Intersex, Two -Spirit (LGBTQI2S) Clients / Consumers with serious mental illness

Specifically, BHCS is seeking Panel Members who have content expertise, lived experience, and / or family experience in the public mental health system, and insight into emerging practices that serve consumers/ clients who are experiencing serious mental health illness. Selected INN Review Panel members will review, score and comment on INN proposals through the secure INN website.

Question Title

Please respond to the following:

Name:

Address:

City:

ZIP:

Email Address:

Phone Number:

Question Title

Please respond to the following:

Represented Organization, if any:

Occupation:

Ethnicity:

Gender:

Orientation:

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Please select all that apply.

I am a consumer of mental health services.

I am a family member of a consumer of mental health services.

I am an Alameda County Mental Health Board Member.

I am a content expert on Isolated Adults/ Older Adults with serious mental illness.

I am a content expert on LGBTQI2S clients/ consumers with serious mental illness.

Question Title

Please choose your age range:

Under 18

19-24

25-34

35-44

45-54

55-64

65+

Question Title

What age range do you serve or represent? Check all that apply.

Children and Youth (0-16)

Transition Age Youth (16-24)

Adults (25-59)

Older Adults (60+)

Question Title

Which area(s) of the County to you provide services in and/or represent? Select all that apply.

North (Alameda, Albany, Berkeley, Emeryville, Oakland, Piedmont)

Central (Hayward, San Leandro, San Lorenzo, Unincorporated Areas)

South (Fremont, Newark, Union City)

East (Dublin, Livermore, Pleasanton)

Question Title

Select your area(s) of expertise. Choose up to four.

Alcohol and Other Drug Services

Community Organizing/Advocacy

Criminal Justice

Education

Foundation/Grant Making

Information/Technology

Law Enforcement/Public Protection

Mental Health Services

Organizational Training/Development

Primary Health Care Services

Public Health Services

Social Services

Other (please specify)

Question Title

What is your professional or personal connection to Alameda County's public mental health system?

Question Title

Describe your experience in reviewing proposals or applications in the selection of grants, contracts or other services.

Question Title

What are the most important aspects of the Innovation Grant program to you?

Question Title

Note: Innovation Panel Review Members must notify Innovation Staff about any affiliation with potential Innovation Grant Round Three applicants and sign a conflict of interest form that prohibits lobbying other Innovation Review Panel Members on the scoring of proposals.

Are you willing to sign a conflict of interest form stating that you WILL NOT apply for Round Three Innovation Grants funding and will not lobby other Innovation Review Panel members on the scoring of proposals?

Yes