Survey & Form Center

2. 
4. Important

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6. Creating A Form Center Account
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8. 2025 Reviewer Bio
10. Are you a Jackson County resident?*

    1. Yes
    2. No
12. Residency Requirment
    jacksoncountycombat.com

    Only applications from Jackson County residents will be considered.

14. First Name*
15. Last Name*
17. Phone Number*
18. email*
20. Address*
22. City*
23. State*
24. Zip Code*
26. Current Position*

    Include current job title and organization for whom you work.

28. Upload Resume*

    Word & PDF Files Accept

30. 1) In which area(s) of the COMBAT mission are you most qualified to evaluate proposals for funding?*

    1. A. Prevention and reduction of drug addiction.
    2. B. Treatment or Recovery programs for substance use disorder.
    3. C. The arrest and prosecution of violent and non-violent drug offenses.
    4. D. The prevention of drug-related offenses.
    5. E. The incarceration, rehabilitation, treatment and judicial processing of those who commit violent and non-violent drug related offenses.
32. You Checked (C):

    1. Violent
    2. Non-Violent
    3. Either
34. 2) Specific Types of Drug Prevention Program Expertise*

    Check all that apply

    1. School-Based
    2. Community-Based
    3. Programs Dealing With Youth
36. 3) Please describe your Education/Training related to Drug Prevention, Violence Prevention or Treatment:*
38. 4) What other experiences would make you a good reviewer for COMBAT’S Drug Prevention, Violence Prevention or Treatment proposals? *
40. 5) Please list any prior proposal review experience: *
42. Acknowledgement*

    1. Agree

    By clicking "Agree," you agree and acknowledge that information and statements provided in this form are, to the best of your knowledge, true and accurate.

44. Signature*

    By typing your name in the "Signature" box below, you acknowledge that this "electronic signature" is valid and binding upon you to the same force and effect of a traditional handwritten signature.

    
    

45. Date*
    Date
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47. 1. Receive an email copy of this form.
48. Email address

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49. Submit

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