MHPSF Evaluator Application Form

  • Evaluator Application Form

    Mental Health Public Safety Fund Grant Reviewers

  • The McLean County Behavioral Health Coordination Department is seeking volunteers to help evaluate proposals for grants and funding oppurtunities that arise from the Mental Health and Public Safety Fund. We are looking to build a diverse pool of volunteers who are passionate about improving behavioral health services in McLean County. Evaluators are needed every couple of months to review items from our department such as RFPs, NOFOs, and Emergent Grants.

    Who Should Apply?
    We welcome any adult who is interested in contributing to the improvement of behavioral health in the county. We especially encourage people with a variety of backgrounds, including:
    · Human service professionals (active or retired)
    · Financial, marketing, or construction professionals (active or retired)
    · Experience with grant writing, applying for grants, or evaluating proposals
    · Lived experience with mental illness, substance use recovery, homelessness, or housing instability

    What Can Evaluators Expect?
    · Evaluators will submit information about their experience and any potential conflicts of interest upon applying and annually thereafter.
    · When grants are available, the Behavioral Health Coordination Department will contact you to confirm interest, any conflicts, and availability before sending materials for evaluation.
    · Evaluators will use a scoring rubric to review grant submissions privately. The required time for evaluation will vary, but typically, evaluators will have 5 days to complete 1-5 hours of work.
    · Evaluators must keep all information about grant submissions and their evaluations private until the McLean County Board makes a final decision on awards.

    If you are interested in volunteering or have questions, please reach out to our Grants Manager, Ashwini Gokhale at ashwini.gokhale@mcleancountyil.gov

    To Note: FOIA Information
    Identities of evaluators are not routinely shared with other evaluators, the McLean County Board, grantees, or as a part of the Grant Awarding process. However, the identity and work of evaluators is subject to requests from the public via the Freedom of Information Act (FOIA).

    If a FOIA request is received related to an evaluation you have worked on, you will be notified. Records released will depend on individual circumstances of the request, but private information, including non-professional contact information and details that evaluators may disclose about their lived experience with mental illness, substance use or homelessness, are not considered eligible records and would be redacted.

  • Do you currently live in McLean County? (not required to be an evaluator)*
  • Have you ever lived in McLean County?*
  • How should we contact you in order to see if you are available for evaluating a grant?*
  • What is the best way for you to receive a submission packet for evaluation? Packets would only be sent to you once we confirm you are interested, available and eligible to evaluate for that package.
  • Format: (000) 000-0000.

  • Experience

  • Evaluators for behavioral health grants from the Mental Health and Public Safety Fund are chosen on a case-by-case basis based on their experience relevant to the grant. Funding opportunities will vary and a wide variety of expertises are desirable.

  • Do you currently work for an organization that provides behavioral health or social services? (Not required to be an evaluator)*
  • Do you, in your current role, routinely interact with clients, consumers, residents who receive services at this organization? (e.g. intake specialist, reception, peer recovery support specialist, counselor, nurse, physician, case manager)*
  • Do you have previous experience working for organizations that provide behavioral health or social services?*
  • The Behavioral Health Coordination department believes that systemic change in behavioral health care requires an effort to include more voices of people with lived experience. Do you identify as someone with lived experience with mental illness, substance use, or homelessness? This information, if shared, will not be connected to your identifying information (e.g. "75% of the evaluators for this grant identified as having relevant lived experience")*
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  • Conflict of Interest Disclosure

  • Evaluators for a grant should not have a substantial conflict of interest with any of the applicants for a single grant. 

    Conflicts of interest include, but aren't limited to:

    • being an employee or board member of an applicant organization
    • having an immediate family member that is an employee of an applicant organization
    • donating to an applicant organization
    • engaging in business transactions with or receiving care from an applicant organization

    Conflicts of interest are often impossible to eliminate entirely in a smaller community, and change often. Evaluators for Behavioral Health grants from the Mental Health and Public Safety Fund will be asked to update their conflicts of interest annually in order to remain eligible as evaluators, and will be asked to confirm their current conflicts before being confirmed as an evaluator for a specific set of submissions. 

  • Do you have any other possible conflicts of interest to list?
  • Other than the conflicts listed above, I hereby declare to the best of my knowledge that I have:

  • I hereby likewise declare that I fully understand that in case any information that may cause me to be in a position that shall be in conflict of interest with regard to my duties and responsibilities arises after this declaration, I shall thereafter inform the Director of Behavioral Health Coordination.

    kelley.amigoni@mcleancountyil.gov

    (309) 888-5700

    200 W. Front St, Suite 304

    Bloomington, IL 61701

    I shall abide by the rules and regulations set forth by the Behavioral Health Coordination department, including it any relevant rules and regulations, with regard to conflict(s) of interest.

    I hereby declare that I make this conflict of interest declaration with the above details being true and correct to the best of my knowledge and in good faith.

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