Form 428A Proposal Reviewer Form

National Science Foundation
DIVISION OF UNDERGRADUATE EDUCATION

REVIEWER BACKGROUND INFORMATION
DATE _________________
1. NAME (TITLE, FIRST, M.I., LAST)

____________________________________________________________________________________
(Enter your name as it should appear on a mailing label.)

2. ACADEMIC RANK or POSITION ____________________________________________________________________________________
3. ADMINISTRATIVE TITLE (if any)

____________________________________________________________________________________

4. DEPARTMENT, SECTION, or OTHER UNIT ____________________________________________________________________________
5. INSTITUTION or ORGANIZATION

_________________________________________________________________________________

6. STREET ADDRESS ________________________________________________________________________________________________
7. CITY, STATE, ZIP

________________________________________________________________________________________________

8. PHONE and FAX:
9. ELECTRONIC MAIL

Office phone (_____) _____ - _______

Home phone (_____) _____ - _______

Fax (_____) _____ - _______

______________________________________________________________________________________________

10. GENDER

r Male

r Female

11. ETHNICITY (check one response)

r Hispanic or Latino

r Not Hispanic or Latino

12. RACE (check one or more)

r American Indian or Alaska Native

r Native Hawaiian or Other Pacific Islander

r Asian

r White

r Black or African American
13. DISABILITY STATUS (check one or more)

r Hearing Impairment

r Other

r Visual Impairment

r None

r Mobility/Orthopedic Impairment
14. TYPE OF EMPLOYING INSTITUTION

r Public University/College
r Private University/College
r Business/Industry
r Government Agency
r K-12 School or School System

If University/College, indicate the highest degree
awarded by that institution:
r Associate
r Master's
r Baccalaureate
r Doctorate
If K-12 School, indicate grade level(s):

_________

r Other
15. EDUCATION

Institution

Discipline

Year of Degree

B.S. (or equiv.)

_______________________________________

_________________________________

___________

M.S. (or equiv.)

_______________________________________

_________________________________

___________

Ph.D. (or equiv.)

_______________________________________

_________________________________

___________

Postdoctoral

_______________________________________

_________________________________

___________

16. AREAS OF EXPERTISE OR SPECIAL INTEREST

__________________________________________________________________________

_______________________________________________________________________________________________________________
17. MOST RECENT PANEL REVIEW AT NSF (if applicable):

Program _______________________________________

Please return this completed form with your résumé or curriculum vitae to:

NSF Form 428A (12/98)

Month/Year _______

NATIONAL SCIENCE FOUNDATION
DIVISION OF UNDERGRADUATE EDUCATION
4201 WILSON BLVD., SUITE 835
ARLINGTON, VA 22230
OMB No. 3145-0060
Expires March 31, 2005

Message to Prospective Reviewers for the

DIVISION OF UNDERGRADUATE EDUCATION*
The National Science Foundation’s Division of Undergraduate Education (DUE) manages several grant programs that support improvement in the quality of undergraduate
education. The NSF staff relies heavily on the judgment of the reviewers in evaluating
proposals submitted to these highly competitive programs. Verbatim but anonymous
copies of reviews, ratings, and associated correspondence are sent to the Principal
Investigator/Project Director. Subject to this NSF policy and applicable laws, including
the Freedom of Information Act (5 USC §552), the identity of reviewers is given maximum protection from disclosure. In addition to providing valuable input to NSF, reviewers report that they professionally benefit from serving on panels.
Reviewers are selected primarily on the basis of discipline and specialty. DUE also
selects reviewers to represent various types of institutions and organizations, geographical areas, and populations. Serving on a panel involves participating in a meeting held in
the Washington, D.C., area for one to three days to read and discuss proposals and write
reviews. NSF directly purchases panelists’ airline tickets and provides panelists compensation to cover hotel and meal expenses.
DUE seeks to maintain a pool of potential reviewers. Persons who send in the Reviewer
Background Information form and a current curriculum vitae may not be invited to
review immediately, but this information is retained for future reference in selecting
reviewers.
The information requested on the Reviewer Background Information form is pursuant to
the National Science Foundation Act of 1950, as amended. Disclosure of all information
is entirely voluntary. The purpose of this background information is to assist in the identification of prospective panelists to review proposals or provide guidance to NSF staff in
connection with the administration of NSF science education support programs. Other
NSF programs requesting names of potential reviewers or specialists in particular fields
may also be given information from this form. 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.

* This message is intended to accompany the Reviewer Background Information form (NSF Form 428A).