Administration for Native Americans (ANA) Panel Reviewer Profile Questionnaire

OMB CN: 0970-0477

Exp. Date: 5/31/2026

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to allow the public to apply to be a peer panel reviewer and allow the Administration for Native Americans (ANA) to select reviewers based on professional qualifications. Public reporting burden for this collection of information is estimated to average .4 hours per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This collection of information is voluntary. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0477 and the expiration date is 5/31/2026. If you have any comments on this collection of information, please contact Amy Zukowski@ [email protected].

1. Name

2. Mailing Address; Primary Email Address; Secondary Email (if applicable); Phone 1; Phone 2

3. Have you previously served for ANA using a different name?

• Yes

• No

3. Please specify your current employer

4. What is your current Position Title?

5. You will be required to participate in lengthy /video conference calls for panel discussions. Does your preferred contact number provide you ample opportunity and time, i.e. unlimited data/phone in a secure, private environment?

• Yes

• No

6. Do you have access to a reliable, consistent internet connection? This is required to use the online Application Review Module and online training.

• Yes

• No

7. Race/Ethnic Heritage (Please check appropriate boxes)

According to 42 U.S.C. § 2991d-1(a)(2), [i]n making appointments to such panels, the Commissioner shall give preference to American Indians, Native Hawaiians, other Native American Pacific Islanders (including American Samoan Natives), and Alaska Natives.

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 Reservations of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.

Native Hawaiian or Pacific Islander

• Native Hawaiian

• Samoan

• Chamorro

• Carolinian

8. If none of the above, do you affiliate yourself with a certain tribe or native community?

• Yes

• No

• If yes, Which tribe or native community?

9. Have you worked with any Tribes or organizations in the last 36 months that would cause you to have a conflict of interest if you were assigned their application?

• Yes

• No

• If yes, please list the Tribe(s) or organization(s)

10. Have you previously served as a grant reviewer for ANA?

• Yes

• No

11. Have you previously served as a grant reviewer for other Federal or Non-Federal agencies or organizations?

• Yes

• No

12. Have you previously served as a Federal reviewer?

• Yes

• No

13. I have limited or no reviewer experience.

• Yes

• No

14. Are you interested in being a Chairperson?

• Yes

• No

15. Have you served as a Chairperson with ANA in the past?

• Yes

• No

16. Please define your primary area of expertise. (Select one)

• Social Development

• Economic Development

• Alaska Native Communities

• Environmental Regulatory Enhancement

• Native Languages: Immersion Programs

• Native Languages: Preservation and Maintenance

17. Please define your secondary area of expertise. (Select one)

• Social Development

• Economic Development

• Alaska Native Communities Environmental Regulatory Enhancement

• Native Languages: Immersion Programs

• Native Languages: Preservation and Maintenance

18. Please define your tertiary area of expertise. (Select one)

• Social Development

• Economic Development

• Alaska Native Communities Environmental Regulatory Enhancement

• Native Languages: Immersion Programs

• Native Languages: Preservation and Maintenance

19. What is your experience working with American Indians, Alaska Natives, Native Hawaiians, and/or Pacific Islanders? (Up to 300 words. A response is required to be considered as a participant)

20. Please provide a brief narrative describing your professional experience/expertise in the topic(s) you selected as your areas of expertise. (Up to 300 words. Do not copy your resume or CV. A response is required to be considered as a participant)

21. Writing Sample - Please read the Evaluation Criteria: Current Community Condition and the excerpt from a sample application below. In the space provided, please draft a response detailing strengths and weaknesses of the application based upon the information provided in the excerpt.

Evaluation Criteria:

Current Community Condition. Reviewers will assess how well the application:

1. Identifies one current community condition to be addressed by the project. Sample Application Excerpt: The challenges or issues faced by the AUIC are varied but all revolve around one theme - the AUIC has been working for years to provide services that meet the unique needs of our native community but infrastructure weaknesses, including staffing shortages, board member professional development, policy and procedure development, community outreach and the development and implementation of additional services have all been hampered by the fact that the AUIC does not have a strategic plan or an infrastructure to implement a strategic. Instead, the AUIC focus has been to pursue money where it is available and provide some services in order to keep the doors open. However, this has been done without involving the community in determining the most pressing priorities. This disconnect often times leaves the most pressing problems unresolved. The current community conditiont is twofold in that to truly build capacity within a small Native Urban organization you must have a multi-pronged approach to build that capacity. Because of the tough economic time faced by all Americans, especially Native Americans, and the severe lack of discretionary funds to meet these needs any organization must address these problems in a holistic manner. We have identified two interrelated challenges that have created our inability to meet our community needs.

Our Current Community Condition is: (1) The staff and Board have never had the opportunity or funds to be trained in organizational management skills necessary to govern and manage a growing non-profit organization and (2) Native Americans within the Aniwer district are not utilizing the social service providers within Aniwer to meet their current needs and to assist in the process of becoming self-sufficient because of a perceived lack of cultural awareness among the social service providers.