National Marine Sanctuary Advisory Council Application F

National Marine Sanctuary
Advisory Council Application Form

Before applying for sanctuary advisory council membership, please review:

1. Sanctuary advisory council charter provided in your application kit;

2. Office of National Marine Sanctuaries (ONMS) National Marine Sanctuary Advisory Council Implementation Handbook available online at http://www.sanctuaries.noaa.gov/management/ac/acref.html (or you may obtain a copy from your local sanctuary); and

3. Importance of Diversity Statement:
   “Whether within a natural ecosystem or a human community, diversity creates strength and resilience. NOAA’s Office of National Marine Sanctuaries values the remarkable diversity of knowledge, perspectives, and experience found throughout sanctuary communities, and invites a wide range of individuals to seek membership on our sanctuary advisory councils. With a diverse membership, advisory councils can broaden access to understanding and participation in marine conservation and governance, foster innovation and creative problem solving, and can help advance the mission of the National Marine Sanctuary System.”

Sanctuary advisory councils advise and make recommendations to the Office of National Marine Sanctuaries on issues regarding the designation and management of national marine sanctuaries. The charter outlines the purposes and governs the operation of the sanctuary advisory council. The handbook provides broader operational requirements for sanctuary advisory councils. In applying for sanctuary advisory council membership, you are agreeing to abide by the terms of the charter and the handbook if you are selected as a council member or alternate.

For those applicants who are considered for selection, the Office of National Marine Sanctuaries will conduct a LEXIS/NEXIS check and a departmental bureau check for potential criminal, political exposure, judgment/lien, adverse media, NOAA enforcement action, and conflict of interest issues. Additional information and guidance regarding the use of the information you submit on this form and its availability under federal law can be found at the end of this form. Please review this information.

For the positions listed in this application, sanctuary advisory council members and alternates must be 18 years of age or older.

Please note, under 18 U.S.C. § 205, federal government employees are not allowed to participate on sanctuary advisory councils in their personal capacities. Federal government employees may be appointed or selected by their affiliated agencies to represent their affiliated agencies in their professional capacities when an advisory council charter includes seats for their affiliated agencies. Special restrictions apply to applicants who are military reservists but are not otherwise employed by the federal government; for additional information, please contact (XXX).

State employees and members of a state legislature are allowed to apply to sit on sanctuary advisory

councils in a personal capacity. State agency employees must provide a letter of support on official agency letterhead from their state supervisor at the time they submit their applications but members of a

state legislature and public university or college employees are not required to provide such letters of support.

State agency employees, members of a state legislature, and local government employees should contact their respective officials to ensure that their state, local government, or employer does not have additional or conflicting laws, regulations, or policies about applying for a position on a federal advisory council.

Please indicate which advertised seat(s) (e.g., Research, Education) you are applying for, provide your contact information, and respond to the questions below. The Office of National Marine Sanctuaries may consider applicants for seats and positions for which they have not applied if the Office of National Marine Sanctuaries believes they are qualified for that seat and are willing to serve in it.

The application deadline is XXX.

Please return all pages of your completed sanctuary advisory council application form, and any attached statements or documents, to: (POC, Address, email and phone).

Date: ___________________

First Name:* _____________________ Middle: ______________ Last: ____________________

*Please include full first, middle, and last names.

Position(s)/Seat(s) applying for:

Maritime History and Archaeology Seat _____

Cultural Engagement Seat _____

Education Seat Education Seat _____

Business and Economic Development Seat _____

Research, Science, and Technology Seat _____

Citizen-at-Large Seat _____

Home Address 1: ______________________________________________________

Home Address 2: ________________________________________________________

Home City: __________________________ State: _________ Zip Code: _____________

Home Phone: _______________________ Cell Phone: _______________________

Home Email: ________________________________

Company/Organization: _________________________ Position/Job Title: __________________

Work Address 1: ______________________________________________________

Work Address 2: ______________________________________________________

Work City: __________________________ State: _________ Zip Code: _____________

Work Phone: _______________________ Work Cell: _______________________

Work Email: ________________________________

Please answer all of the questions below thoroughly and in numerical order on a separate attached document with each answer clearly marked with the corresponding question number. Answers should be no more than two paragraphs.

1. How familiar are you with the community or area associated with the sanctuary?

2. Have you attended previous sanctuary advisory council meetings or sanctuary advisory council working group meetings?

3. Why are you interested in serving on the sanctuary advisory council? Please include what you hope to gain from participating on the sanctuary advisory council.

4. Describe what you think the role of the council is, and how you will work to best support the sanctuary as a sanctuary advisory council member or alternate.

5. One of the key roles of a sanctuary advisory council member is to serve as a liaison between the sanctuary and its community. Explain how you will coordinate with, consult with, and inform the members of the constituency you will represent (ex: a Research seat), if appointed to that seat (ex: for a Research seat, members of the sanctuary’s research constituency). If you are applying for more than one seat, please provide responses for each constituency and be clear on which constituency you are referring to.

6. Describe how you will work to ensure that diverse perspectives and underrepresented communities are represented through the sanctuary advisory council.

7. Explain your views regarding the protection and management of marine or Great Lake resources, including natural (fish, coral reefs, etc.), historic or cultural resources.

8. Describe your formal community and professional affiliations and employment. In particular, highlight how your particular expertise and experience relate to the goals and uses of the sanctuary and the seat(s) for which you are applying. Be sure to include qualifications that you have or other information that you think would be relevant and beneficial to the advisory council.

9. Will you commit to participate in sanctuary advisory council activities (e.g., meetings, constituent outreach, retreats, chairing or participating on a subcommittee or working group, and reviewing written materials)?

10. How did you hear about the opportunity to apply for this sanctuary advisory council seat?

OPTIONAL

Answering the following questions is optional. None of your answers in this section will affect the Office of National Marine Sanctuaries’ consideration of your application or your ability to apply or join the advisory council. After applying, this information will be used to help understand how well NOAA’s Office of National Marine Sanctuaries is inclusive of and serves all of our communities. ONMS will retain and file the selected applications in a secure location that is only accessible to staff and is approved for storage of personally identifiable information (e.g., in a locked filing cabinet or in a secure computer folder). According to the NOAA Records Schedule 100-16, these applications will be destroyed when no longer needed for current agency business. We are required to use the language and definitions from the Statistical Policy Directive No. 15: Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity and Executive Order 13985 for the following demographic questions:

1. Gender: (Select all that apply)

• Female

• Male

• Transgender, non-binary, or another gender

• Prefer not to answer

2. Do you identify with any of the following groups that the federal government, in Executive Order 13985, has identified as underserved? Check all that apply.

• Members of religious minorities

• Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons

• Persons with disabilities

• Persons who live in rural areas

• Persons otherwise adversely affected by persistent poverty or inequality

• No, I do not identify with any of these groups

3. What is your race and/or ethnicity? Select all that apply and enter additional details in the spaces below.

• American Indian or Alaska Native - Enter, for example, Navajo Nation,

Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of

Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.

____________________________

• Asian - Provide details below.

Chinese	Asian Indian	Filipino
Vietnamese	Korean	Japanese

Enter, for example, Pakistani, Hmong, Afghan, etc. _____________

• Black or African American - Provide details below.

African American	Jamaican	Haitian
Nigerian	Ethiopian	Somali

Enter, for example, Trinidadian and Tobagonian, Ghanaian, Congolese, etc._____________

• Hispanic or Latino

Mexican	Puerto Rican	Salvadoran
Cuban	Dominican	Guatemalan

Enter, for example, Colombian, Honduran, Spaniard, etc._____________

• Middle Eastern or North African

Lebanese	Iranian	Egyptian
Syrian	Iraqi	Israeli

Enter, for example, Moroccan, Yemeni, Kurdish, etc. _____________

• Native Hawaiian or Pacific Islander

Native Hawaiian	Samoan	Chamorro
Tongan	Fijian	Marshallese

Enter, for example, Chuukese, Palauan, Tahitian, etc. _____________

• White

English	German	Irish
Italian	Polish	Scottish

Enter, for example, French, Swedish, Norwegian, etc. _____________

The Office of National Marine Sanctuaries wants to remove, or reduce, a barrier to participation in an advisory council for individuals who would otherwise experience financial hardship, due to costs such as time off work, arranging for childcare, or making accommodations due to a disability or impairment. A stipend per meeting attended can help offset the expenses incurred by members to attend meetings and provide their expertise. The stipend is not intended as compensation or payment for services. If you are interested in opting in for a stipend, please fill out the following questions. Your answers to these questions will not affect in any way the Office of National Marine Sanctuaries’ consideration of your application and will not result in any disadvantage or impact to your candidacy.

1. Would your place of employment or stakeholder organization compensate you for your participation on this Advisory Council? (Yes or No):_________

   1. If not, please fill out the follow up questions.

2. It would be a financial challenge for me to actively participate in this Advisory Council without receiving a stipend per meeting. (Yes or No): _________

   1. If yes, would you like to receive a stipend for participation in each advisory council meeting? (Yes or No): _________

We trust our advisory council applicants will provide an honest assessment of their own financial need for a stipend in order to attend and participate in Advisory Council meetings, understanding that at least some members/alternates may have a more significant financial need for a stipend than others. Your answers to the above questions do not guarantee a stipend. The availability of stipends depends on the Office of National Marine Sanctuaries’ budget for the advisory council. Stipends are granted at the discretion of the Office of National Marine Sanctuaries.

Additional Information

Information obtained through this application process will be used to determine the qualifications of the applicant for membership on the sanctuary advisory council. The Office of National Marine Sanctuaries affirms it intends to disclose the applications only to Department of Commerce/National Oceanic and Atmospheric Administration staff, including employees, grantees, and contractors, with a need to know the information in the applications to complete the application review process, and to current sanctuary advisory council members who serve on the applicant review panel. However, if you prefer that your application be reviewed by NOAA staff only and not disclosed to current council members as part of the evaluation process, please contact the sanctuary advisory council coordinator [INSERT CONTACT INFORMATION] to request internal review only, which will not result in any disadvantage or impact regarding your candidacy. The Office of National Marine Sanctuaries may be required to disclose the applications in response to a court order, a congressional request, or a request from the public under the Freedom of Information Act (FOIA).

If disclosure is requested under FOIA, the Office of National Marine Sanctuaries will endeavor to protect the privacy of applicants by withholding personal information, such as home addresses and telephone numbers of applicants, as well as names or other identifying information of applicants who are not chosen as members of the council. In contrast, other information may be released, including names of applicants who are chosen as members of the council, other information in chosen members’ applications that relate to their qualifications to be a member or alternate, including education and professional experience, and statements of philosophy or opinions contained in the application. Applying for membership on the sanctuary advisory council is voluntary.

Public reporting burden for this collection of information is estimated to average one hour and fifteen minutes per response, including the time for reviewing instructions, searching existing data sources, gathering the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the Office of National Marine Sanctuaries, 1305 East West Highway, N/NMS, Silver Spring, Maryland 20910.

Notwithstanding any other provision of law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number.

Privacy Act Statement

Authority. The collection of information concerning the solicitation for applications for sanctuary advisory councils is authorized under the National Marine Sanctuaries Act, 16 U.S.C. 1445a, and Executive Order 13178, and in accordance with the Privacy Act of 1974, as amended, (Privacy Act) 5 U.S.C. 552a.

Purposes. The collection of names, contact information, professional information, qualifications, and answers to the application questions is required in order for the Office of National Marine Sanctuaries to evaluate and appoint members to the sanctuary advisory councils. The information collected will be reviewed by NOAA employees, and may also be reviewed by current sanctuary advisory council members as part of the evaluation process.

Routine Uses. NOAA will use the application information for the purposes set forth above. The Privacy Act authorizes disclosure of the collected information for the following purposes: to NOAA staff for work-related purposes; for other purposes as set forth in the Privacy Act; and for routine uses published in one or more of the following Privacy Act System of Records Notices, as applicable: COMMERCE/DEPT-11, Candidates for Membership, Members, and Former Members of Department of Commerce Advisory Committees, available at https://www.osec.doc.gov/opog/PrivacyAct/SORNs/dept-11.html; COMMERCE/DEPT-18, Employees Personnel Files Not Covered by Notices of Other Agencies, available at https://www.osec.doc.gov/opog/PrivacyAct/SORNs/DEPT-18.html; and OPM/GOVT-1, General Personnel Records, available at https://www.opm.gov/information-management/privacy-policy/sorn/opm-sorn-govt-1-general-personnel-records.pdf, which cover certain records regarding Federal employees and may also cover records of individuals who are not Federal employees who, through their service on a sanctuary advisory council, may be considered as volunteers providing gratuitous services to the agency without compensation; and, for individuals who are also members of a Regional Fishery Management Council, COMMERCE/NOAA-13, Personnel, Payroll, Travel, and Attendance Records of the Regional Fishery Management Councils.

Effects of Not Providing Information. Providing the application information is voluntary; however, if the information is not provided, the individual will not be considered for appointment as a member of a sanctuary advisory council.

Consent. By submitting an application to the Office of National Marine Sanctuaries for appointment to a sanctuary advisory council, you are consenting to the use and disclosure of the information for the purposes and routine uses described above. However, if you prefer that your application be reviewed by NOAA employees only and not disclosed to current council members as part of the evaluation process, please contact the sanctuary advisory council coordinator [INSERT CONTACT INFORMATION] to request internal review only, which will not result in any disadvantage or impact regarding your candidacy, or for any questions regarding this Privacy Act Statement.

OMB Control #0648-0397

Expires DATE

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