Name(required) Email(required) Phone Number(required) Position(required) Are you or your organization an active member of the MO BoS CoC?(required) Select one option Yes No Please state the complete name of your organization (or invested individual).(required) Address(required) Please mark any and all of the below funding sources that your agency receives, directly, as a sub-recipient, or as part of an expectation in a partnership agreement or MOU(required) CoC ESG MHTF MoHIP Direct HUD Grants Other My agency receives no grants, directly or indirectly, from these funding sources. Rank and Review Panel Opportunities (you may select more than one panel to apply for, if multiple options are available)(required) CoC NOFO Please select any and all funding that your organization is intending to apply for or renew in the future:(required) CoC NOFO CoC CE RFP CoC DV SSO YHDP RFP None of these Do you have expertise in the following areas:(required) Social Services Housing Services Behavioral Health Data Victim Services Youth Services Personal Experience of Homelessness Homelessness Services Other Grant Management: Please explain your experience with grant management. Please include information about writing, reviewing, administering, and compliance. The selection panel is looking to establish your specific experience and knowledge in this area; this is not an extensive list of all grants your agency has administered.(required) Past CoC Rank and Review Experience: Have you ever served on a CoC Rank and Review Panel in the past? If so, please list the CoC you served with and provide the dates, years, or competitions you ranked.(required) Past Grant Review Experience: Have you ever served as a grant review on any other grant competition? Which one, and when did you serve in this role?(required) Please explain why you want to serve on the Rank and Review Panel.(required) Please mark the below statements as either true or false. Please also note that “MO BoS CoC funds” refers to both current funding and any new funding that may be applied for. I believe I can serve on the Rank and Review Panel as an objective person without favoritism to any organization that may apply for funds.(required) Select one option True False My agency does not receive MO BoS CoC funds.(required) Select one option True False My agency is not a subrecipient of another agency that receives MO BoS CoC funds.(required) Select one option True False My agency is not in a partnership, agreement, contract, or MOU to provide services to another agency that receives MO BoS CoC funds, either paid or unpaid.(required) Select one option True False My agency, including our staff and volunteers, does not serve in a leadership or board role with any agency applying for funds in the competition for which I am interested in serving on the review panel.(required) Select one option True False I have reviewed the list of current CoC funded agencies to ensure there is no conflict of interest with my participation and the above checked statements.(required) Select one option True False I understand the Rank and Review Panel will be an extensive commitment of my time during the short, but time limited, period of Rank and Review.(required) Select one option True False I am committed to the time required for a successful panel and understand this may require travel, evening meetings, and weekend responses.(required) Select one option True False Please type your name in the box below, acting as an electronic signature. While some time with the Rank and Review Committee will be done on your own time, some meetings may take place during the normal working hours. If you are not the Executive Director or CEO of your agency, please have your direct supervisor sign your application (in the next field) so that they are aware you may need to miss work time to serve on the Rank and Review Panel.(required) If needed, please have your supervisor type in their name as an electronic signature below, indicating that he or she understands that the applicant listed above may need to miss work time to attend Rank and Review Panel meetings, and that approval is given for the applicant's involvement on the panel. Date of Signature(s) and Submission (YYYY-MM-DD)(required) Send
