Reimagine Public Safety Act Grant Reviewer Interest Survey

The Illinois Department of Human Services is committed to building a diverse team of volunteer grant reviewers to ensure a reflective, robust, and comprehensive merit-based review process. Your participation as a reviewer will directly impact the success of our efforts to support and implement the Reimagine Public Safety Act throughout the State. If you'd like to play a key role in decisions that empower and support people throughout Illinois, please complete the IDHS RSPA Grant Reviewer Interest Survey below:

Section I - Contact Information

First Name:

Last Name:

Address:

City, State, ZIP:

Email:

Phone:

Section II - Professional Experience

Are you employed by or in any way (Board or other Management Affiliation) associated with an organization that intends to apply for available funding? (This information helps us to avoid conflicts of interest when assigning application reviewers.)
Select one... Yes No Not Sure

Current Employer:

Employer Address:

City, State, ZIP:

Area(s) in which you have work or lived experiences and expertise (check all that apply):

• Violence Prevention
• Youth Development
• High Risk Youth Intervention
• Victim Services
• Trauma Informed Mental or Behavioral Health
• Street Outreach
• Case Management
• Public Safety
• Program Planning/Development/Management
• Grantmaking processes
• Grant writing
• Other

Provide details about your skills, experience, and specialties in the text box below:

Do you have prior experience reviewing grant funding opportunities?
Select one... Yes No

Section III - Demographics (Voluntary)

(It is important to us that we include a wide range of diverse perspectives among the group of people who will review these applications. Please answer the questions below to help us select volunteers from a variety of backgrounds and lived experiences.)

How old are you?
Select one... Under 18 18-24 years old 25-34 years old 35-44 years old 45-54 years old 55-64 years old 65+ years old

Gender:
Select one... Female Male Non-binary Transgender Agender Other

What is the highest level of education you have completed?
Select one... Some high school or less High school diploma or GED Some college, but no degree Associates or technical degree Bachelor's degree Graduate or professional degree (MA, MS, MBA, PhD, JD, MD, DDS)

Are you of Spanish, Hispanic, or Latino origin?
Select one... Yes No

Race (check all that apply):

• Black or African American
• American Indian or Alaska Native
• Asian
• Native Hawaiian or Other Pacific Islander
• White
• Other

Disability:
Select one... Yes No

Section IV - Availability

Are there any periods of time (i.e. full months or weeks) during the months of February through June 2022 you would be unavailable:
Select one... Yes No

If you answered yes, please specify periods of time (i.e. full months or weeks) during the months of February through June 2022 you will not be available:

How did you hear about this opportunity?