Art and Humanities

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Arts and Humanities Council of Montgomery County
Advisory Review Panelist Application Form


Last Name	First Name	Title (Mr., Dr., etc)

Street Address

City	State	Zip Code

Work Number	Hom Number	Email

Please check the categories below to indicate the areas of expertise that you will bring to the panel process:

	Arts Education			Literature / Writing
	Awareness of Specific Culture or Ethnicity			Media / Communications
	Comparative Religion			Museums / Museum Activities
	Dance			Musical Theater
	Ethics			Theater
	Folk Arts / Traditional Arts			Other
	Historical Societies and Related Historical Activities			Philosophy
	Instrumental Music			Visual Arts
	Language / Linguistics			Vocal Music

On a separate sheet, please provide a brief description of your arts, humanities, and/or community experiences and expertise, past experience in working with a group decision-making process, knowledge of grants review, nonprofit experience, or knowledge of other information that you believe would be an asset to the grant review process.

Please attach a resume or biographical description

Please complete the conflict of interest form

Advisory Review Panelist Conflict of Interest Form

Please list the Montgomery County arts and humanities organizations in which you are a paid member (e.g. Olney Theatre Center, Montgomery County Historical Society

Are you currently serving on the board of Directors or Trustees of any Montgomery County arts or humanities organization? If yes, which organization(s)?

No Yes

Have you served on the Board of directors or Trustees of any Montgomery County arts or humanities organization during the past 12 months? If yes, what organization(s)?

No Yes

Are you currently emplyed by or serving as a contractor to any Montgomery County arts or humanities organization? If yes, what organization(s)?

No Yes

Were you employed by or serving as a contractor to any Montgomery County arts of humanities organization during the past 12 months? If

No Yes