Grant Reader Interest Form

First Name

Last Name

Organization

Address / City / Zip

Preferred Phone Number

Email Address

Have you volunteered as a grant reader before?

Do you have any particular strengths, interests, or professional knowledge that you bring to the review panel?

Are you able to attend the grant orientation and subsequent panel meetings?

Please select your first panel preference.

Please select your second panel preference.

Is there any particular reason for your preference?

Please use the following space to list any agencies with which you may have a conflict of interest (including those that you or family members are associated with as employees, consultants or volunteers; you will be asked to sign a more specific Conflict of Interest policy prior to volunteering.)

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