TM-32 FMPP Grant Peer Reviewer Qualifications Template (for gr

OMB No. 0581-NEW

Farmers Market Promotion Program

Room 3012 South Tower1800 M Street, NW

Washington DC 20036

www.ams.usda.gov/FMPP

(202) 694-4000

Farmers Market Promotion Program

Grant Peer Reviewer Qualifications Template

______________________________________________________

(Print your name here.)

Instructions for completing this template:

1. Attach a SUMMARY OF QUALIFICATIONS (A brief description of why you consider yourself qualified to be selected as a reviewer and how you will contribute to the FMPP review process).

2. Attach your RESUMÉ (please include the names of organization board(s) on which you serve or for whom you volunteer).

3. Complete and check the APPROPRIATE BOXES below.

Current Employment/Volunteer (select as many as appropriate):

Name of Employer:
Name of Organization(s)/Market(s) At Which You Volunteer:				Retired from the Organization(s) / Employer Listed Below:
Federal Employee		State Employee		Nonprofit Employee
Farmer/Producer/Rancher		Local Government		Tribal Government
Economic Development Corporation		Public Benefit Corporation		Private Sector Employee

Field of Expertise / Subject Specialist (select as many as appropriate):

Grant Writer		Educator/Academia		CSA
Agricultural Production/Rancher		Financial/Budget		Ag Cooperative
Nutrition		SNAP / SNAP (EBT) at Farmers Markets		Environmental (Green Technology)
Architecture/Engineering		WIC		Distribution
Farmers Market Manager		SFMNP		Agri-Tourism
Farmers Market		Roadside Stand Operator		Direct Marketing
Other:	Please describe:

4. EMAIL OR FAX THE TEMPLATE AND YOUR RESUME to:

Carmen Humphrey, Branch Chief – Carmen.Humphrey@ams.usda.gov

Ricardo Krajewski, Economist – Ricardo.Krajewski@ams.usda.gov

Alicia Bell-Sheeter, Ag Communications Specialist – Alicia.Bell-Sheeter@ams.usda.gov

Karl Hacker, Economist – Karl.Hacker@ams.usda.gov

Linda Browne, Ag Marketing Specialist – Linda.Browne@ams.usda.gov

Camia (Mia) Lane, Ag Marketing Specialist – Camia.Lane@ams.usda.gov

Fax: 202-694-5949

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0581-NEW  The time required to complete this information collection is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program.  (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD).  To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

“Encouraging the Development Promotion and Expansion of Direct Marketing”

TM-32