Programs

Self Nomination Form - Grant Panel

Thanks for your interest in serving as a Panelist for the Pennsylvania Partners in the Arts Advisory Panel.

First Name: *

Last Name: *

Street Address: *

City, State Zip Code: *

Organization/Company:

Title:

Daytime telephone number: *

Email address: *

Are you available for Wednesday, August 8, 2012?: *

Yes

Panelist Information

The Pennsylvania Council on the Arts asks that each PPA partner work to have panelists that are representative of our service areas. Therefore, to ensure diversity of opinion and background in our panels we ask the following voluntary questions.

Do you have experience in a particular artistic discipline?:

If yes, which one(s)?:

County of residence:

Gender:

Ethnicity:

Are you Hispanic or Latino?:

Have you ever served on a PPA Panel?:

If yes, please specify year(s):

Resume:

If available, please attach your resume in Open Document, Microsoft Word, text or PDF format.

Do you have any questions or comments?:

American Indian/Alaska Native
Asian
Black/African American
Native Hawaiian/Pacific Islander
White
Other

Programs

Self Nomination Form - Grant Panel

Programs Links