Attachment: D
Review Panel Statement of Interest
Human Services Grants Program FY2023-27
All individuals interested in participating in the HSGP RFP review panel completed the statement of interest on the following page. Each statement was reviewed by an ad hoc committee formed by the We Are Santa Moncia Fund advisory board.
The We Are Santa Monica Fund is a partnership between community donors, the California Community Foundation, and the City of Santa Monica. The Fund provides grants to local nonprofit organizations to support the local economy, advance equity, improve physical and environmental health, and offer resources and emergency relief.
Human Services Grants Program
2023-27 HSGP Proposal Review Panel
Statement of Interest Instructions
The We Are Santa Monica Fund (WASMF) is a partnership between community donors, the California Community Foundation, and the City of Santa Monica. The Fund provides grants to local nonprofit organizations to support the local economy, advance equity, improve physical and environmental health, and offer resources and emergency relief. As part of the 2023-27 Human Services Grants Program Request for Proposals (HSGP RFP), City staff is partnering with the WASMF Advisory Board to conduct an open solicitation for qualified individuals to participate in the review of HSGP Proposals.
The HSGP Proposal Review Panel will include subject matter experts in service provision for youth and families, people with disabilities, people experiencing homelessness, seniors, and other underserved populations, generally. Subject matter experts will understand the needs of individual vulnerable populations as well as nonprofit operations and/or service delivery, including the use of evidence-based best practices. Additional panelists may include other stakeholders, such as City staff, individuals serving on Santa Monica boards, commissions, community groups, or neighborhood associations, and include those with lived experience as consumers of services. Panelists may also include representatives from a diverse group of related fields, including public policy, social services, financial and assurance services, philanthropy, non-profit management, and diversity, equity and inclusion.
The 2023-27 HSGP RFP is scheduled to close on Wednesday, January 18, 2023, with reviewers set to score proposals during the month of February 2023. Prospective reviewers must be prepared to commit at least 10-15 hours to the scoring process for individual proposal review and review panel group discussion. By submitting a Statement of Interest, prospective reviewers agree to provide their time on a volunteer basis, and without compensation.
All individuals interested in participating in the HSGP RFP review panel must complete the Statement of Interest form on the following pages. In order to be considered, completed forms must be submitted to [email protected] by 6PM on Mon, November 14, 2022. Statements of Interest will be reviewed by a sub-committee of the WASMF advisory board in order to determine which individuals are seated as panelists.
Please visit https://www.santamonica.gov/human-services-grants-program for updates.
Human Services Grants Program
2023-27 HSGP Proposal Review Panel
Statement of Interest
Personal Information
Name:
Email: Phone:
Occupation: Employer:
Optional Demographic Information
Race/Ethnicity: Gender:
Age: Sexual Orientation:
Disability Status: Veteran Status
Professional and Personal Experience
1. Please share any relevant experience, skills, or qualifications in the following areas:
a. Personal and/or professional experience with underserved or marginalized populations (including, but not limited to, people experiencing homelessness, early childhood, youth and families, seniors, and people with disabilities).
Response:
b. Experience with non-profit operations and management or administrative oversight of social services (including service on non-profit boards, City of Santa Monica boards, commissions, or City Council).
Response:
c. Lived experience as a consumer of services* (including as a person who is or was formerly homeless; person who has experienced mental illness and/or substance abuse; person who is low-income and/or disabled; person who is or has been enrolled in a Santa Monica social service program).
Response:
2. Please describe your interest in participating in the Santa Monica HSGP RFP process as a scorer/rater and your connection to Santa Monica, if any.
Response:
3. Please disclose any potential conflict(s) of interest related to your participation in the review and scoring of HSGP Proposals for City funding. The purpose of requesting this information is to identify, disclose, and manage any actual, potential, or perceived conflicts of interest to protect the integrity of the review and selection process. We seek to identify such conflicts that may influence reviewers to use their position for financial benefit, private gain or advantage, or other personal purposes.
A conflict of interest here is defined as any formal or informal relationship with nonprofits or organizations that may apply for HSGP funding which may reasonably compromise one’s ability to fairly carry out any assigned duties as a reviewer. Conflicts may be actual, potential, or perceived and may relate to financial or nonfinancial interests in potential applicant organizations. Financial interests may include, but are not limited to, the actual or contingent possibility of any monetary or proprietary benefits or gain of any sort that has or may be received from such organizations. Nonfinancial interests may include, but are not limited to, receipt of gifts, board membership, officer positions, employment positions, volunteer service, and participation in or receipt of direct program services involving such organizations. Conflicts may also include related interests by close relatives (wife, husband, registered domestic partner, son, daughter, mother, father, brother, or sister).
The City may request additional information if your response is unclear or incomplete.
Response:
I certify that the information I have provided is true and correct to the best of my abilities. I certify that, if selected, I will commit to the necessary time required to complete the scoring and rating process.
Signature Date