Fillable FY2022 OREGON CULTURAL TRUST GRANT PANELIST NOMINATION FORM (Oregon Cultural Trust)

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FY2022 OREGON CULTURAL TRUST GRANT PANELIST NOMINATION FORM (Oregon Cultural Trust)

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The Cultural Trust, Cultural Development Program applications are reviewed and scored by individuals chosen for their diverse cultural
expertise and geographic, ethnic and gender diversity. Panel scores are used to rank the applications. Based on this ranking, Trust
staff prepares funding recommendations that are approved by the Cultural Trust Board of Directors.
Please use this form to nominate yourself or another individual to serve as a Cultural Trust grant review panelist. The information
provided will be used to evaluate qualifications of potential panelists, to contact the nominee, and if the nominee is appointed, to
update the Cultural Trust’s administrative records. The Cultural Trust may wish to publicly acknowledge serving panelists- please alert
staff if you do not wish to have your name published.
Full Name
Address
City, State, ZIP
Phone
Email Address
Qualifications & Professional Experience (attach
resume)
Are you/is the nominee available to spend up to 6
hours on a panel conference call in June?
Why do you/why does the nominee want to be a Trust
grant panelist?
Has the nominee previously served on an Oregon
Cultural Trust panel?
N/Y
What year(s)?
Category(s) nominee most interested in serving as a
panelist?
Preservation (Tuesday, June 8)
Access (Thursday, June 10)
Creativity (Tuesday, June 15)
Capacity (Thursday, June 17)
To better assist us in meeting our affirmative action objectives, we would appreciate information about your gender identity and background.
This information is optional and is used for data collection only. Under state and federal law, this information may not be used to
discriminate against you. Thank you for your participation.
Gender Identity:_________________________ LGBTQ: Disability:_________________________________
Race/E
thnicity (select one):
African American/Black: American Indian/Alaskan Native: Asian:
Caucasian/White: Native Hawaiian/Pacific Islander: Multi/Other: _______________________
Please return completed form to aili.schreiner@oregon.gov. FY2022 application guidelines are posted on www.culturaltrust.org.
FY2022 OREGON CULTURAL TRUST
GRANT PANELIST NOMINATION FORM
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FY2022 OREGON CULTURAL TRUST GRANT PANELIST NOMINATION FORM (Oregon Cultural Trust)

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Completed 18 April 2021

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