Arts Panelist/Juror Registration

Regional Arts Panelist/Juror Registration

Thank you for your interest in being an Artist Support Grant Panelists. Please fill out the info below in order to participate in this year's survey.
Date

MonthDayYear
Date
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Where do you currently reside? You do not need to be from one of the 4 counties to participate. *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I will:

Participate in the Panel Review onlyParticipate by reading and rating every application (review online)I will do both the Rating and the Panel DiscussionWhichever is needed mostPeer Review Only, as needed
I have interest in helping with:

Grassroots Grant / Organization Applications for Arts ProgramsArtist Support Grant Applications / Individual artists seeking to advance their careers"Best in Show" Art/Artist Booth Reviews for Gallery Exhibits or Events
Please let us know the days/times that best suit your fall schedule. We would like to have all decisions made by the first week of October if possible.
If participating in the Panel meeting please select the preferred date you could participate.

August 29August 30Sept. 5thSept 6thNone of these work - please suggest another dateOther
If participating in the Panel meeting please select the time block(s) that best fit your schedule. Can put specific time blocks in the "other" option if desired.

MorningMiddayAfternoonEveningWeekdays/EveningsWeekendsOther
Please select your preferred meeting type
Profession
Briefly describe your mediums of expertise and/or qualifications:*
You do NOT have to be an artist to be a juror.
Panelists and Jurors must disclose if they know an applicant and may need to abstain from voting, especially if they are related or close friends. Do you agree to disclose any relation to an artist or organization?

YesNoOther
The N.C. Arts Council and all of its panelists/jurors will not discriminate on the basis of race, color, national origin, disability, age, or sex and which require accessibility for persons with disabilities. Do you understand and agree to abide by this requirement?

YesNoOther
I shall avoid conflicts of interest and any conduct that may suggest the appearance of impropriety in the disbursement of funds.

If a potential conflict of interest arises, the panelist will disclose the potential conflict to WAC staff or the review committee. Further, panelists shall not vote on nor participate in the solicitation, negotiation, formation, award, arbitration, modification, or settlement of any contract or grant involving any State funds or any dispute arising under such contract or grant when the panelist stands to benefit, either directly or indirectly, from such contract or grant.
Have you read the statement above, and do you agree to the terms?
Please tell us more about you!
Optional: Who are you, what do you do? Bio? Don't be shy!
Paste any links to social or websites that would help us get to know you more.
Optional
Upload a photo of yourself or your work - this could be used to promote you as a panelist or judge

Cancelof
Thank you so much!
Did someone refer you to be a juror/panelists? If so, who?
If applicable
I am willing to:

Review Grant Applications for Artists (NC Artist Support Grant) (any mediums)Review Grant Applications for Arts Organizations/Programming (Grassroots Grant)Juror Performing/Musical Arts/ArtistsJuror Visual Arts/Crafts Exhibitions/Shows/EventsJuror Visual Arts/Crafts - Artists CompetitionsOther
Should be Empty:

Regional Arts Panelist/Juror Registration

Thank you so much!