U.S. Department of Education
Office of Special Education 
and Rehabilitative Services (OSERS) 

OSERS Peer Reviewer Qualifications Statement

(Please complete ALL PAGES of this form.)

NAME: ,
Last First and Middle

SOCIAL SECURITY NO:

ADDRESS
(WORK):

Institution/Agency

Department/Division

Street

City State Zip Code

ADDRESS
(HOME):

Street

City State Zip Code

SEX:

M Male

F Female

ETHNICITY:

American Indian

Asian or Pacific Islander

Afro-American not Latino Origin

Latino

White, not Latino Origin

Other; please specify:

HIGHEST DEGREE RECEIVED:

Diploma

Associate/Certificate

Baccalaureate

Masters

Intermediate

Doctorate

M.D. (Medical Doctor)

RESUME/VITA:

Provided

Not Provided

ARE YOU THE PARENT OF AN INDIVIDUAL
WITH A DISABILITY?

No

Yes

If "Yes"--Disability:

DO YOU HAVE A DISABILITY?

No

Yes

If "Yes"--Disability:

Do you need personal assistance, interpreter,
or other accommodation to participate in
panels?

No

Yes

If "Yes"--Specify:

OSERS PEER REVIEWER
AREAS OF EXPERTISE CHECKLIST

Please check your primary areas of expertise:

Office of Special Education Programs:

Early Intervention

Elementary Education

Secondary, Transition, and
Post-Secondary Education

Cognitive Disabilities

Psycho-Social-Emotional Disabilities

Sensory Disabilities

Physical Disabilities

Technology

Research; specify areas:

Training

Parent/Family

Self-Determination

Media/Captioning

State Education Agencies

National Institute on Disability and
Rehabilitation Research:

Research Methodology

Computer Science and
Technology

Rehabilitation Engineering

Medical Sciences

Vocational Rehabilitation

Independent Living

Sensory Disabilities

Physical Disabilities

Psychiatric Disabilities

Developmental Disabilities

Cognitive Disabilities

Technology Transfer

Statistics and Demographics

Rehabilitation Services Administration:

American Indians with Disabilities

Migrants and Seasonal Farmworkers

Projects with Industry

Recreational Programs

Special Projects for the Severely
Disabled

Supported Employment

Independent Living

Protection and Advocacy of Individual
Rights

Training; specify areas:

Generic Areas:

Disability Policy

Disability Advocacy and Rights

Multicultural Issues

Inclusion

School Reform and Restructuring

Regular Education/
Special Education Relationships

Comments:


Contact: Dr. James Button, OSERS Peer Reviewer Coordinator,
Office of Special Education and Rehabilitative
Services,
U.S. Department of Education,
400 Maryland Avenue, SW--Mail Stop 2525
Washington, DC 20202
FAX: (202) 205-9252
Telephone: (202) 205-823