DEPARTMENT OF EDUCATION

 

AGREEMENT FOR GRANT APPLICATION REVIEWERS

 WHO RECEIVE COMPENSATION

 

 

FREEDOM OF INFORMATION ACT

 

I understand that under the Freedom of Information Act the Department may release my reviews verbatim to the public.  The Department may also release individual reviewers' names in conformance with the Department's disclosure policy, but generally will not identify an individual reviewer with the review of a particular application. However, to avoid complicating the release of reviews, I agree not to make comments which could be seen as offensive or constitute an invasion of privacy of any individual.

 

CONFIDENTIALITY OF DOCUMENTS AND RESTRICTION ON CONTACT

 

I agree that assistance applications are made available to grant application reviewers solely for the purpose of reviewing those applications against the selection criteria of the grant program.

 

I also agree not to discuss the information, concepts, and procedures contained in the applications outside the Department during or after the review process, and to discuss them within the Department only with the panel members and in the context of and under the procedures for application review.  I agree to follow the written instructions provided by the Department for the completion of technical review forms.  I also agree to return the applications to the Department or dispose of them if so instructed.  I agree to retain no copies of documents or parts of documents related to this review. 

 

I agree not to contact the originator of the application being reviewed concerning any aspects of its contents.

                                                                                                       

CONFLICT OF INTEREST

I certify to the best of my knowledge I do not have a conflict of interest with respect to any of the applications being considered for this competition. 

 

I understand that I will be considered to have a “conflict of interest” when I, or certain individuals and entities with whom I have a relationship, have a financial interest in the outcome of this competition. 

 

For example, I will have a direct conflict of interest in this competition if

 

§         For an application submitted to this competition,  I have agreed to serve as an employee or consultant on the project, or have been offered the opportunity to do so and have not yet accepted or declined, if a grant is awarded, or if my personal financial interests will otherwise be affected by the outcome of the competition; or

 

§         I helped prepare an application in the competition, even if I have no financial interest in the success or failure of that application.

 

I will also have a conflict of interest if certain entities or individuals I have a relationship with have a financial interest in the outcome of the competition.  For example, I will have a conflict of interest if any of the following would benefit financially in any way from an application in the competition being funded:

 

§         My spouse, my child, a member of my household, or any relative with whom I have a close relationship;

Page 2 - Agreement for Grant Application Reviewers

 

§         Any employer I have served within the last 12 months, my business partner, an organization that I have served as an officer, director, or trustee within the last 12 months, or an organization that I serve as an active volunteer;

 

§         Any person or organization with whom I am negotiating or have an arrangement concerning future employment;

 

§         Any professional associate, including any colleague, scientific mentor, or student, with whom I am currently conducting research or other professional activities or with whom I have conducted such activities within the last twelve months; or

 

§         Any individual with whom I have or have had a personal relationship where the nature, duration or recency of that relationship would impair my ability to impartially review any application in the competition.

 

The above is a list of examples, only.  This list is not exhaustive.  Therefore, I will also promptly notify the appropriate Program Official if I become aware of any other circumstances that might cause someone to question my impartiality in serving as a reviewer for this competition.  I further agree to promptly notify the appropriate Program Official if, while reviewing the applications assigned to me, I discover that I may have a conflict of interest.

 

AGREEMENT ON SCOPE OF WORK

A.      Before reviewing and scoring any application, I will carefully read all instructions to reviewers, priorities (if applicable), regulations, criteria, and the technical review forms, all of which will be made available to me by the appropriate Program Official;

 

B.       I will carefully review and score all applications provided to me;

C.       I will score each application solely on its content and the degree to which the application meets the appropriate priorities and criteria; and

D.       I will complete a technical review form for each application, record the scores in the space(s) provided, sign and date the form, and return it to the appropriate Program Official.

 

 

_________________________________                                   ______________________________

Printed or Typed Name of Reviewer                                                 Signature of Reviewer      

 

                                                                                                                ______________________________

                                                                                                                Date

 

 

 

 

 

 

 

ED Form 5249  6/02

(Previous editions of this form are obsolete.)