EDU - Sigma Abstract/Grant Reviewer Application

Sigma Theta Tau International

Abstract/Grant Reviewer Application Form

Please complete ALL of the required information below and click the "Submit Form" button to save your information. Note, the application can be saved and returned to at a later time. You must complete all fields for the required information before the form can be saved.

PERSONAL INFORMATION

Full Name*

First Name

Initial (optional)

Last Name

Suffix (optional)

Credentials (List only degrees that HAVE BEEN completed, i.e., PhD, RN, BS, BA, etc.)*

Position Title (i.e., Assistant Research Scientist, Associate Professor)*

Which is your preferred mailing address?*

Home Work

Have you been an active reviewer with Sigma in the last 12 months?*

Yes No

Active Reviewer = involvement in abstract and/or grant reviews at least once in the last 12 months

What programs have you reviewed for Sigma?*

Abstracts Only Grants Only Both Abstracts and Grants

Do you want to apply to review grants in addition to abstracts?*

Yes No

Do you want to apply to review abstracts in addition to grants? *

Yes No

WORK ADDRESS INFORMATION

Institution/Organization Name (Affiliation)*

Department/Group*

Work Address (Do Not Report Workplace Name)*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Phone Number*

International Format Required (US - +1)

Fax Number

International Format Required (US - +1)

HOME ADDRESS INFORMATION

Home Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Phone Number*

International Format Required (US - +1(317)634-8171)

EMAIL ADDRESS

By submitting this form you are giving Sigma permission to contact this person about this application. This email address will not be sold to or shared with other organizations, nor will it be included in any publications by Sigma.

An alternate email address is strongly recommended! Automatic email confirmations and all meeting correspondence will be sent to your main and alternative email addresses. An alternative email address will NEVER be displayed online or on any printed documentation.

Email Address*

Confirm Email Address *

Alternate Email Address

Confirm Alternate Email Address *

CONTACT (SECRETARY / ASSISTANT)

Name

First Name

Last Name

Office Phone Number

International Format Required (US - +1)

Email Address

Confirm Email Address *

MEMBERSHIP AND EDUCATION

Please note: Your curriculum vitae (CV) may be requested for verification of information provided.

Are you an active member of Sigma?*

Yes No

Membership Number*

Region of Preferred Chapter*

Africa Region Chapter Number - Name*

Asia Region Chapter Number - Name*

Europe Region Chapter Number - Name*

Latin America/Caribbean Region Chapter Number - Name*

Middle East Region Chapter Number - Name*

Oceania Region Chapter Number - Name*

North America Region 1 Chapter Number - Name*

North America Region 2 Chapter Number - Name*

North America 3 Region Chapter Number - Name*

North America 4 Region Chapter Number - Name*

North America 5 Region Chapter Number - Name*

North America 6 Region Chapter Number - Name*

North America 7 Region Chapter Number - Name*

North America 8 Region Chapter Number - Name*

North America 9 Region Chapter Number - Name*

North America 10 Region Chapter Number - Name*

North America 11 Region Chapter Number - Name*

North America 12 Region Chapter Number - Name*

North America 13 Region Chapter Number - Name*

North America 14 Region Chapter Number - Name*

North America 15 Region Chapter Number - Name*

Highest Degree Attained*

What nursing degree(s) have you obtained? (Check all that apply)*

Diploma Associates Baccalaureate Masters Doctorate

Education (Include basic preparation through highest degree held. Please show for each degree: degree, year -- Institution name, city, state, country -- major area of study. Separate each entry with a line break.)*

Example: BS, 1973 -- Tufts University, Somerville, MA -- Nutrition

REVIEWER PREFERENCES

You indicated an interest in continuing as an abstract reviewer and applying as a grant reviewer. Please select "Both Abstracts and Grants" regarding your interest as a reviewer. A full application will be required to add the opportunity to add grant reviewer to your application.

You indicated an interest in continuing as a grant reviewer and applying as an abstract reviewer, please select "Both Abstracts and Grants" regarding your interest as a reviewer. A full application will be required to add the opportunity to add abstract reviewer to your application.

Indicate your interest as a reviewer.*

Sigma Abstracts Sigma Grants Both Abstracts and Grants

Select all abstract programs, which you feel you are qualified to review; however, a minimum of one program must be selected. Putting down more abstract areas will not mean that you have to complete more reviews.*

Clinical Practice Education Evidence-Based Practice Leadership Research

GRANT REVIEWER AREAS OF EXPERTISE

Adult Health Options

Men Older Adults Women

Clinical Practice Options

Evidence-Based Practice Healthcare Delivery Nursing Administration Practice Environments Workforce Development

Educational Research Options

Technology

Family Health Options

Adolescents Children Infants Mothers & Infants

Health of Diverse Populations Options

Health Disparities Health Literacy Health Numeracy Immigrant Health Underrepresented Populations

Health Policy Options

Global Local National Regional

Stress and Health Options

Intervention Studies Stress Effects Stress Management

Symptom Management Options

Acute Disease and Injury Chronic Disease and Injury Intervention Studies Self-Management

Other

Other:

REVIEWER QUALIFICATIONS

Peer-Reviewed Presentations (List peer-reviewed presentations from state, regional, national, or international conferences within the last five (5) years.)*

Use the two lines on the bottom right-hand corner to expand this text field.

Approximately how many peer-reviewed presentations have you done in the last five (5) years?*

Publications (List manuscripts published within peer-reviewed or scientific journals within the last five (5) years.)*

Use the two lines on the bottom right-hand corner to expand this text field.

Approximately how many manuscripts and/or book chapters have you published in the last five (5) years?*

Grants (List title and type of grants (e.g., Research, EBP, Education) for ongoing and completed work received at a state, regional, national, or international level within the last five (5) years.)*

Use the two lines on the bottom right-hand corner to expand this text field.

Approximately how many grants have you received in the last five (5) years?*

Reviewer Experience (List all experience as an abstract reviewer, journal review panel member, and/or grant reviewer at a state, regional, national, or international level within the last five (5) years.*

Use the two lines on the bottom right-hand corner to expand this text field.

Approximately how many abstracts have you reviewed in the last five (5) years?*

Approximately how many manuscripts and/or book chapters have you reviewed in the last five (5) years?*

Approximately how many grants have you reviewed in the last five (5) years?*

Staff Review #1

Abstract Score

Grant Score

Applicant indicated interest as an abstract reviewer*

Yes No

Applicant indicated interest as a grant reviewer.*

Yes No

Applicant is an eligible Sigma member.*

Yes No

Applicant is indicates they are a current active reviewer.*

Yes No

Verify that the applicant has reviewed at least once in the last 12 months

Applicant has at least a master's degree.*

Yes No

Applicant has at least a doctoral degree.*

Yes No

Number of peer-reviewed presentations given meets minimum requirements.*

Yes No N/A

Number of manuscripts and/or book chapters published meets minimum requirements. *

Yes No N/A

Number of grants received meets minimum requirements.*

Yes No N/A

Number of abstract reviewed meets minimum requirements.*

Yes No N/A

Number of manuscripts and/or book chapters reviewed meets minimum requirements.*

Yes No N/A

Number of grants reviewed meets minimum requirements.*

Yes No N/A

Applicant meets all minimum requirements for an abstract reviewer.*

Yes No

Applicant meets all minimum requirements for a grant reviewer.*

Yes No

Applicant can be auto-accepted or auto-rejected for ALL applied for.*

Yes No

Application requires further review.*

Yes No

Ensure that either auto-acceptance/rejection is selected yes or that further review is selected yes to proceed on to RSAC review.

N/A is for current active reviewers that have not provided detailed information on application.

Sigma Staff Assignment to RSAC

Needs Further Review

Please select the individuals or group that the application is being assigned.

Staff Assignment - Assign RSAC Reviewer #1*

Staff Assignment - Assign RSAC Reviewer #2*

Staff Assignment - Assign RSAC Reviewer #3*

Staff Assignment Electronic Signature*

Nurse Planner Education Staff

Staff Assignment Date*

RSAC Reviewer #1

Review Required

Complete a review of the reviewer application and indicate whether the individual meets the requirements needed to act as a Sigma Abstract and/or Grant Reviewer.

Reviewer #1: Full Name*

First Name

Initial (optional)

Last Name

Reviewer #1: This applicant does not meet all minimum requirements to be accepted; however, based on your review of their application, how would you rate them?*

Acceptable Somewhat Acceptable Neutral Unacceptable Totally Unacceptable

Reviewer #1: I recommend that the applicant be:*

Accepted as an Abstract Reviewer only. Accepted as a Grant Reviewer only. Accepted as both an Abstract and a Grant Reviewer. Not accepted as either an Abstract or a Grant Reviewer.

Reviewer #1: Please share any comments you may have regarding this applicant. Note all comments could be shared with applicant.

Note all comments could be shared with applicant. Your comments will be provided to applicants for constructive feedback and future improvements.

Reviewer #1: Electronic Signature*

Research and Scholarship Advisory Member Nurse Planner Education Staff

Reviewer #1: Date*

RSAC Reviewer #2

Review Required

Complete a review of the reviewer application and indicate whether the individual meets the requirements needed to act as a Sigma Abstract and/or Grant Reviewer.

Reviewer #2: Full Name*

First Name

Initial (optional)

Last Name

Reviewer #2: This applicant does not meet all minimum requirements to be accepted; however, based on your review of their application, how would you rate them?*

Acceptable Somewhat Acceptable Neutral Unacceptable Totally Unacceptable

Reviewer #2: I recommend that the applicant be:*

Accepted as an Abstract Reviewer only. Accepted as a Grant Reviewer only. Accepted as both an Abstract and a Grant Reviewer. Not accepted as either an Abstract or a Grant Reviewer.

Reviewer #2: Please share any comments you may have regarding this applicant. Note all comments could be shared with applicant.

Note all comments could be shared with applicant. Your comments will be provided to applicants for constructive feedback and future improvements.

Reviewer #2: Electronic Signature*

Research and Scholarship Advisory Member Nurse Planner Education Staff

Reviewer #2: Date/Time*

RSAC Reviewer #3

Review Required

Complete a review of the reviewer application and indicate whether the individual meets the requirements needed to act as a Sigma Abstract and/or Grant Reviewer.

Reviewer #3: Full Name*

First Name

Initial (optional)

Last Name

Reviewer #3: This applicant does not meet all minimum requirements to be accepted; however, based on your review of their application, how would you rate them?*

Acceptable Somewhat Acceptable Neutral Unacceptable Totally Unacceptable

Reviewer #3: I recommend that the applicant be:*

Accepted as an Abstract Reviewer only. Accepted as a Grant Reviewer only. Accepted as both an Abstract and a Grant Reviewer. Not accepted as either an Abstract or a Grant Reviewer.

Reviewer #3: Please share any comments you may have regarding this applicant. Note all comments could be shared with applicant.

Note all comments could be shared with applicant. Your comments will be provided to applicants for constructive feedback and future improvements.

Reviewer #3: Electronic Signature*

Research and Scholarship Advisory Member Nurse Planner Education Staff

Reviewer #3: Date/Time*

ABSTRACTS FINAL REVIEW

Final decision regarding reviewer application that required additional review.

Abstract Final Review: The application has undergone further review and the decision made by the Research and Scholarship Advisory Council members is to:*

Accept as an Abstract Reviewer. Not accept as an Abstract Reviewer.

Abstract Final Review: Electronic Signature*

Nurse Planner Education Staff

Abstract Final Review: Date*

GRANTS FINAL REVIEW

Final decision regarding reviewer application that required additional review.

Grants Final Review: The application has undergone further review and the decision made by the Research and Scholarship Advisory Council members is to:*

Accept as a Grant Reviewer. Not accept as a Grant Reviewer.

Grants Final Review: Electronic Signature*

Nurse Planner Grant Coordinator

Grants Final Review: Date*