2019 Community Connections Volunteer Proposal Review Registration
Your Contact Information
Current County of Residence
Have you lived, worked, or volunteered in any of the 18 counties eligible for 2018 Community Connections grants? If yes, please indicate the counties below. If not, please select "Other" and indicate the Ohio counties with which you are most familar. (Note: This will help us place you in the proper region for reviewing proposals.)
How did you hear about this opportunity?
HealthPath Pre-Application Webinar
HealthPath web site
HealthPath board member or staff
Coworker or colleague
Employed full- or part-time
I have ready access to a high-speed Internet connection for the training webinar. (We will make other arrangements for people who may not have ready access to a high-speed Internet connection.)
Demographic Information (optional)
HealthPath will use this information to help create diverse, balanced proposal review teams.
Ethnicity (please select all that apply)
American Indian or Alaskan Native
Black or African American
Hispanic or Latino
Native Hawaiian or other Pacific Islander
Please indicate the best days/times you would be able to participate in the in-person proposal review meeting. We will divide reviewers into regional teams and will host one meeting per team. These meetings will last approximately 2 hours. We will try to host the meetings in locations that are no more than an hour's drive for the reviewers on that team. Please factor in travel time when making your selections.
These responses are for planning purposes only. HealthPath will confirm meeting time, dates, and locations as soon as the proposal review teams are set.
Monday, February 18
Tuesday, February 19
Wednesday, February 20
Thursday, February 21
Monday, February 25
Tuesday, February 26
Wednesday, February 27
Conflict of Interest
Is your employer currently applying for a Community Connections grant? (Note: You will still be able to serve as a reviewer even if your employer is applying. You just won't be able to review that proposal.)
I am currently affiliated with the following not-for-profit organizations or government entities. (Please list each organization and briefly describe your association, e.g. "MercyHealth, board member" or "Santa Maria Community Services, volunteer.")
My spouse/partner and/or member of my immediate family works for or is currently affiliated with the following not-for-profit organizations or government entities. (Please list each organization and briefly describe the association, e.g. "Spouse, YWCA, board member".)
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