Please take a moment to complete the survey questions below if you are interested in serving as a grant review panelist for COA's Supporting Arts grant program.

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* 1. Contact Information

First Name

Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Occupation

Title/Occupation

Organization Affiliation

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* 3. Have you, as an individual or on behalf of an affiliated organization, applied for a grant from the Connecticut Office of Arts?

Yes

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* 4. Have you, as an individual or has an organization with which you are affiliated, received a grant from the Connecticut Office of Arts?

Yes

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* 5. Do you have experience as a grant reviewer?

Yes

If yes, please specify.

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* 6. Background and Expertise: Please select the areas in which you feel qualified to review.

Accessibility

Arts Administration

Community/Cultural/Economic Development

Diversity, Equity and Inclusion (DEI)

Finance/Accounting

Non-profit Management

Programming

Strategic Planning

Other (please specify)

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* 7. Resume upload

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 8. Bio - include experience and qualification relevant to the arts.

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* 9. Tell us why you are interested in serving as a grant review panelist?

Optional - Demographics
In order to best represent the arts field in Connecticut, we are seeking a broad panel of potential grant reviewers. Information you provide will be used to ensure that the panel of reviewers is an equitable representation of Connecticut's population.

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* 10. Race/Ethnicity (check as many as applicable)

Afro Latino

American Indian

Black/African American

Caribbean

Central American

Chicano

Mexican

Middle Eastern/North African

Native Alaskan

Pacific Islander/Native Hawaiian

South American

Southeast Asian/Asian

White/Caucasian - origins in Europe

Other

Prefer Not to Respond

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* 11. Age Range

18-24

25-34

35-44

45-54

55-64

65+

Prefer Not to Respond

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* 12. Other Identifiers (check as many as applicable)

Military (Veteran, Active Duty or Reservist)

Formerly incarcerated

LGBTQ+

Person with a disability

No other identifiers

Prefer Not to Respond

Other (please specify)