Fillable Hazard Mitigation Assistance Grants Review & Ranking Panel (Arizona)

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Hazard Mitigation Assistance Grants Review & Ranking Panel (Arizona)

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Date:
County:
Agency or Political
Sub-Division:
Point of Contact: Title:
Office Phone #: Address:
Email Address: City & Zip:
Point of Contact: Title:
Office Phone #: Address:
Email Address: City & Zip:
Point of Contact: Title:
Office Phone #: Address:
Email Address: City & Zip:
Point of Contact: Title:
Office Phone #: Address:
Email Address: City & Zip:
Point of Contact: Title:
Office Phone #: Address:
Email Address: City & Zip:
Point of Contact: Title:
Office Phone #: Address:
Email Address: City & Zip:
Hazard Mitigation Assistance Grants Review & Ranking Panel Pool
Arizona Dept. of Emergency and Military Affairs
OR (please select one)
I understand that if my agency has submitted a Notice Of Intent for a grant that will be
reviewed during that panel's formation, that I will not be asked to join the panel for
that grant's panel formation. I will remain on the list for future panels.
Option 1- I would like to participate, when available, for a future HMA Grants
Review & Ranking Panel. Please place me on the list of possible panelists. I am listed
as the Point Of Contact below.
Option 2 - Our agency has not identified a specific individual at this time, but
would
like to participate in future panels. Please place our agency on the list and contact the
Point Of Contact below, as needed. We will select an agency representative at that
time.
Have you participated in a Grant Review & Ranking Panel for DEMA before?
Have you participated in a Grant Review & Ranking Panel for DEMA before?
Have you participated in a Grant Review & Ranking Panel for DEMA before?
Have you participated in a Grant Review & Ranking Panel for DEMA before?
In addition to the POC above, our Agency has additional individuals available, who would like to participate in
a future panel. They are listed below.
Please return completed form to: Tom.Jones@azdema.gov
Have you participated in a Grant Review & Ranking Panel for DEMA before?
Have you participated in a Grant Review & Ranking Panel for DEMA before?
Check if Yes
Check if Yes
Check if Yes
Check if Yes
Check if Yes
Check if Yes
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Hazard Mitigation Assistance Grants Review & Ranking Panel (Arizona)

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Completed 12 August 2020

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