DCASE Cultural Grants Program - Apply to be a Panelist * 1. Contact Information Name: Home Address: City (must live in City of Chicago) State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Email: Phone: * 2. Highest educational degree earned (high school, college/university, graduate degree) * 3. Are you a practicing artist? Yes No * 4. Are you a nonprofit arts and culture professional? Yes No * 5. What is your profession? * 6. Please upload a current resume. * 7. Which of the below are the artistic disciplines do you feel most familiar? (check all that apply) Architecture Arts Service Organization (trade association for specific arts disciplines) Culinary Arts Curatorial Arts Dance Design (includes fashion, industrial, and costume) Fashion Film Interdisciplinary/Multi-Disciplinary Literature Literary Arts Media Arts/Film Museum Music Performance Art Theater Visual Arts (includes Graphic Artists) * 8. Are you able to commit/dedicate approximately 25 hours to participating in a grant review process? Yes No Done