Public Media belongs to you! And it can look and sound like you too! We invite you to help shape the future of public media in Vermont as a member of the Vermont PBS and VPR Community Forum. This application should take you approximately 15 minutes.

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* 1. First name.

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* 2. Last name.

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* 3. Pronoun preference.

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* 4. Mailing address.

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* 5. Email address.

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* 6. Phone number. Answer in this format 000-000-0000.

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* 7. What is your preferred method of contact?

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* 8. What is your age?

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* 9. How do you identify?

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* 10. Describe your professional skills, areas of expertise and/or training. 500 character maximum.

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* 11. Do you watch Vermont PBS? If no, skip to Question 13.

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* 12. How many years have you been watching Vermont PBS programming?

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* 13. Which Vermont PBS channels do you watch? Click all that apply.

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* 14. Do you listen to VPR? If no go to Question 17.

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* 15. How many years have you been listening to VPR?

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* 16. Which VPR stations/services do you listen to? Click all that apply.

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* 17. How do you watch or listen to Vermont PBS and VPR? Click all that apply.

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* 18. Tell us a little about yourself in a few sentences. Include background information and community involvement. 500 character maximum.

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* 19. List two or three reasons, why are you interested in joining the Community Forum. 500 character maximum.

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* 20. What unique or personal perspective would you bring to the Community Forum? 500 character maximum.

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* 21. Have you previously served on the Vermont PBS Community Council or the VPR Community Forum? Click all that apply.

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* 22. How did you learn about the Community Forum? Click all that apply.

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