Grant Panelist Application Form For assistance or questions, please contact the Terri at the Arts Council at 813.276.8250. Name* First Last Residential Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Zip Code Email* Phone*EXPERIENCEEmployer*Occupation*Arts & Culture Expertise*Please select all that apply. Dance Design Arts Education Folk Arts Literary Arts Media Arts Music Theatre Visual Arts Areas of Arts and Culture ExpertisePlease select all that apply.DanceDesign ArtsEducationFolk ArtsLiterary ArtsMedia ArtsMusicTheatreVisual ArtsBusiness Expertise*Please select all that apply. Accounting/Finance Arts Administration Development Marketing/Communications/PR Nonprofit Management Public Administration Other (see resume) Areas of Business ExpertisePlease select all that apply.Accounting/FinanceDevelopmentMarketing/Communications/PRNonprofit ManagementPublic AdministrationHave you any experience as a grant panelist?*YesNoIf yes, please explain (type of grant program/granting organization).Type of Grant Panel You Would Prefer* Artist Grants Community Projects Cultural Organization Grants Type of Grant Panel PreferredPlease select all that apply. Refer to our Grant Program Overview document (linked above) for more information about the programs. Artist GrantsCommunity Organization GrantsCultural Organization GrantsPlease tell us why you think you will make a good grant panelist.*(750 characters)CULTURAL EQUITYWe ask applicants to self-identify their age, gender, ethnicity/race in order to help us meet our goal of providing cultural equity in our programs and services. Age Range* 21-29 30-39 40-49 50-59 60+ Prefer not to answer Gender* Female Male Transgender Prefer not to answer Ethnicity/Race*Please select all that apply. African American/Black American Indian/Alaska Native Asian American Hispanic/Latina/Latino Native Hawaiian/Pacific Islander White Prefer not to answer Ethnicity/RaceSelect all that apply.African American/BlackAmerican Indian/Alaska NativeAsian AmericanHispanic/Latina/oNative Hawaiian/Pacific IslanderWhiteOtherPrefer not to answerResume/CVUpload Your FilePlease upload your current resume or CV in PDF format. To ensure we can identify your resume, please be certain your last name is part of the file name. Accepted file types: pdf, doc, docx.