Public Reviewer Application::Public Reviewer Application Form

In accordance with the NIH Privacy Protecting Guidance, NIMH stores personal information provided through this application only for use by the Review Branch, to qualify the individual to serve as a Public Reviewer. Your name and other personally identifiable information will be encrypted and securely stored on NIMH computer systems. NIMH does not disclose, give, sell or transfer any personal information, unless required for law enforcement or by statute. Questions about NIMH privacy policies may be directed to the NIMH Privacy Coordinator

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Public reviewers read and provide written critiques (usually 1-3 paragraphs) of grant applications. Their critiques focus on the strengths and weaknesses of the application's public health significance and/or innovation; on the feasibility of plans for recruitment, retention, and follow-up of subjects; on outreach efforts to special and historically disadvantaged populations; and on issues pertaining to the protection of human subjects. At review meetings, public reviewers join the discussion of applications with scientific reviewers and vote on the merit of each application discussed. Review meetings are typically held in the Washington, DC area or by video conference call.
See the Applying to be a Public Reviewer page for more details.

Person

* Last Name:

Middle Initial:

* First Name:

Title:

(for example, Mr., Ms., or Dr.)

Demographic information is collected by NIH in order to establish and maintain balanced review panels.

Home Address

* Street Address:

* City:

* State:

* Zip:

Phone Contacts

* Primary Phone:

Secondary Phone:

Other Phone:

Email Address

* Email:

* Confirm Email:

Work Address

Street Address:

City:

State:

Zip:

Qualifications

How did you hear about the (call for) NIMH Public Reviewers:

Reason for interest in Public Reviewer position with NIMH:

Experience

Please explain your experience with the Mental Health Community by completing the text fields below. Each of the text fields is limited to 4000 characters. At least one experience is required.

EXPERIENCE 1: With mental disorders as a mental health care practitioner, payer or policy maker:

EXPERIENCE 2: As a research participant in studies of mental disorders:

EXPERIENCE 3: In a community service setting involving representation of the interests and perspectives of people with mental disorders, e.g., service on mental health boards or committees , relevant publications, or presentations:

EXPERIENCE 4: Personal experience with mental disorders, e.g., personal experience; family member, caregiver, or supporter of such a person. Specifics/disclosure not required:

Availability

Please show your availability for in-person meetings (in Washington, DC) and/or teleconferences.

Teleconference:	Winter	Summer	Fall
In Person Meetings:	Winter	Summer	Fall

Attachment

Please attach your most current Curriculum Vita/Resume (You can attach up to three files):

Attachment 1:

Attachment 2:

Attachment 3:

Submit

Please review your entries then click the Submit Application button to forward your resume to NIMH.
Thank you for applying to serve as a Public Reviewer. An email will be sent confirming your submission.

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