Panelist Nomination Form

  • Name
    Address
    City
    State
    Zip Code
    Phone
    Disciplinary Expertise
    Chamber Choral/Vocal Dance
    Humanities Jazz/Blues Literature
    Media Arts Multidisciplinary Opera/Musical Theater
    Orchestra/Band Photography Theater
    Traditional Arts Visual Arts    
    None of the above (list appropriate discipline) 
    Have you previously served as a Peer Review Panelist?
    Yes     No
    Which Organization?   
    Which Year?   
    Experience (check the appropriate answer(s))
    Advertising / Marketing / Promotion Arts Administration
    Arts Education Arts/Cultural Research
    Arts & Humanities Arts & Technology
    Arts or Cultural Fair / Festival Management Capital Improvements / Facilities Construction
    Collaborative Programs / Partnerships Community-Based Program Development
    Curriculum Development / Fund Raising
    Development Publishing Historical Programs
    Local Arts Organization Development Programs for Persons with Disabilities
    Science Touring / Presenting
    Youth Programs Zoological Programs
    For required reporting purposes only, MCACA requests that perspective panelists select the appropriate ethnicity.
    In the space provided, submit a brief biography (include formal and informal education as appropriate, as well as pertinent experience).
    Verification (Type the words you see in the picture below)