First Name * Last Name * Organization Address / City / Zip Preferred Phone Number Email Address * Have you volunteered as a grant reader before? Yes No 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? * Yes No GRANT READER ORIENTATION: Monday, October 17, 2018 from 7:45 - 9:00 AM. GRANT PANEL MEETING(S): Meet one or two times as needed during the month of November, no longer than 2-3 hours each meeting (to be scheduled by each panel during the Grant Reader Orientation). Please select your first panel preference. * Education Income Health Community Strengthening Financial Review Please select your second panel preference. Education Income Health Community Strengthening Financial Review 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.) CAPTCHAThis question is for testing whether you are a human visitor and to prevent automated spam submissions.