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I would like to serve as a Grant Review Panelist.
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check one
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Last Name:
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First Name
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Middle
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Street Address
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City, State, Zip
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Telephone (day)
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Telephone (eve)
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Fax
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Email Address:
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Job Title or Area of Expertise
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Organization/Company Name
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Gender
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Age
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Race/Ethnicity:
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County of Residence
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Experience (Check all applicable):
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Artist/Arts Educator
Community Development
Fundraising
Budgeting/Finance
Needs Assessment/Program Planning/Program Evaluation
Nonprofit or Public Agency Administration/Management
Nonprofit or Public Agency Governing Board or Committee
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I may have a conflict of interest.
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I am a member of governing board or policy making committee.
I have significant business relationship with the organization.
I conduct an annual independent audit of the organization.
I am an employee or paid consultant of the organization.
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List the organization(s) with which you are affiliated that might create a conflict of interest
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I would be available to serve on a Review Panel at TAF:
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Thursday, May 15, 2008 – 9-11 a.m.
Thursday, May 15, 2008 – 1-3 p.m.
Friday, May 16, 2008 – 9-11 a.m.
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I will attend this Grant Panelist Training Session at TAF:
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Accessibility Accommodations for Training and Panel Meetings
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