Form 3135-0098 Panelist Profile Form

Panelist Profile Form
Mr. ___

Mrs. ___

Ms. ___

Dr. ____

Last Name

First Name

Middle Initial

Cell Phone (area code/number)

Home Phone (area code/number)

Work Phone (area code/number)

FAX (area code/number)

Email Address
Title, Role, or Profession
Organization (if applicable)
Home Address: (Street Address, City, State, Zip)
Mailing Address (if different from above): (Street Address, Suite #, City, State, Zip)
Type of Address: Work _____ Other _____
Are you self-employed/freelance?
Yes___ No___
Do you have broadband internet access? Yes___ No___
Are you a federally registered lobbyist? Yes___ No___

Are you a layperson? Yes___ No___

Special Characteristics:
a. Which of the following describes your
Ethnicity? Please select only one:
___ Hispanic or Latina/o
___ Not Hispanic or Latina/o
b. Which of the following describes your race?
Please select one or more:
___ American Indian or Alaskan Native
___ Asian
___ Black or African American
___ Native Hawaiian or Other Pacific Islander
___ White
Select one category (optional):
___ Female ___Male ___

Select the appropriate disability
category(ies)(optional):
___ Visual
___ Hearing
___ Mobility
___ Other
Language skills (optional):
Please indicate if you have reading and oral
comprehension skills in the following languages:
___ Spanish ___ French ___ Other (specify)
_______________________________________
_______________________________________
Recommended by:
_______________________________________

Arts Expertise:
(Make selections from the List of Codes attached to the Instructions)
Primary Arts Expertise
Other Arts Expertise
Other Arts Expertise
Other Arts Expertise
Other Arts Expertise
Other Arts Expertise

___
___
___
___
___
___

___
___
___
___
___
___

___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___

___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___
___ ___ ___

Work Experience:
Select up to five types of organizations with which you have had working arts experience:
Arts/Cultural Organization
___ performing arts (dance, folk arts, music
Opera, musical theater, theater)
___ non-performing arts (design, folk arts,
Literature, media, museums, visual arts)
___ arts service organization
___ regional arts organization
___ state arts agency
___ local arts agency
___ artists’ community/live-work space
___ other

Media/Journalism
___ commercial film/radio/television
___ internet/mobile art production (??)
___ public media
___ independent production company
___ newspaper/magazine
___ internet-based news/feature website
___ blog
___ trade publication
___ scholarly journal

Educational Organization/School Association
___ pre-kindergarten/early childhood
___ K-12
___ college/university
___ professional school
___ professional association
___ other

Museums/Galleries/Spaces
___ art
___ natural history/history
___ university

Funding Organization
___ public
___ private
___ corporate

Publishing
___ arts periodical
___ general periodical
___ commercial
___ independent press
___ internet
___ university
___ distributer/wholesaler

National Endowment for the Arts

Panelist Profile Form
Instructions

Arts Endowment panelists’ advice plays a central role in reviewing applications for funding.

We rely on panels composed of individuals who represent a broad range of artistic and cultural viewpoints and wide
geographic and ethnic diversity.

Our panels are composed of both arts experts and knowledgeable laypersons.

Most panelists are arts experts – persons who are qualified by their training, skills, or experience in one or more art
forms. Every panel also includes a layperson – someone knowledgeable about the arts but not engaged in the arts
as a profession.
We maintain a database with informationto about individuals’ expertise and experience in the arts help us
identify and select qualified panelists,
If you are interested in becoming a panelist (or have been a panelist in the past and want to update your
information), please complete and return the Panelist Profile Form so that we will have accurate information
about your qualifications and how to contact you.

Resumé

Since the information provided on the Panelist Profile Form is a simplified description of your background and
qualifications, please also send us a one or two page current resumé. Please identify your most significant and
relevant performances; films; exhibitions; artworks; books, articles, or other published writings; honors, awards or
other recognitions; board or other memberships; whether you have a professional license (if applicable in your
field); and any relevant international art activities.

How to Complete the Form…

If you have the form in hard copy, please type or print legibly and check all appropriate boxes. Email or fax the form
to us along with your resumé.
Please read the notes and instructions below before you complete the form.
Home Address/Mailing Address
Please give us your home address, since We keep track of the geographic representation on our panels by home city
and state. If this is not also your preferred mailing address, include that as well, and fill in the appropriate checkbox.
Arts Expert or Layperson?
-- Consider yourself an arts expert if you work in the public, private, or nonprofit sector with job responsibilities in
the arts or in cultural planning or funding. You may be an artist, arts administrator, arts scholar, foundation staff
member administering arts-related programs, arts educator, or a staff member of a state, local or regional arts
organization or arts consortium, among others.
-- Consider yourself a layperson if you are knowledgeable about the arts but are not engaged in the arts as a
profession. Your expertise may be demonstrated through recognition of your arts knowledge by arts professionals,
your leadership in the arts, your involvement in the arts through significant volunteerism, or your demonstrated
expertise in artistic genres or arts-related fields.
3

Broadband Internet Access
Panelists now review both application narratives and work samples in an online system, so broadband internet
access is important to an individual’s ability to easily participate in the review process.
Federally Registered Lobbyists
Arts Endowment panels are considered advisory committees. On June 18, 2010, President Obama signed a
Presidential Memorandum directing agencies in the Executive Branch not to appoint or re-appoint federally
registered lobbyists to advisory committees and other boards and commissions. We ask for this information so that
we can comply with this prohibition.
Special Characteristics
The Arts Endowment’s enabling legislation requires panels that are ethnically diverse, so we ask for information to
comply with the statute. The classifications are prescribed by the Federal Government’s Office of Management and
Budget for Federal reporting and statistical activities. They do not determine eligibility for participation on Arts
Endowment panels. Identification of gender, disabilities, and language skills is voluntary.
The categories are designed to identify your basic racial and national origin. Please complete both sections a) and
b). If you are of mixed racial and/or national origin, you may check more than one box. Choose the category(ies)
with which you most closely identify yourself, as described:
Ethnicity:
Hispanic or Latino/a: A person of Mexican, Puerto Rican, Cuban, South or Central American, or other
Spanish culture or origin, regardless of race.
Race:

American Indian or Alaska Native: A person having origins in any of the original peoples of North and South
America (including Central America), and maintaining tribal affiliation or community.
Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian
subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam.
Black or African American: A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander: A person having origins in any of the original peoples of Hawaii,
Guam, Samoa, or other Pacific Islands.
White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Foreign Languages
Please list any non-English language(s) in which you are fluent.
Who is recommending this person?
If you are sending in the form on your own initiative, write in SELF under “Recommended by:” If you are completing
the form at someone else’s request, please include that person’s name, title, and organization. If you’re filling out
the form recommending someone else, please list your name, title and organization here

4

Arts Expertise
This section lists the skills, experience, and/or training in the arts that you can contribute to a panel. A List of Codes
for a variety of arts fields, roles, and areas of specialization is included with the form. Write the appropriate code
numbers in the boxes on the Profile Form (one digit per box). Please choose codes that most closely represent your
areas of expertise. (See example below)
Primary Arts Expertise: From the List of Codes choose the arts field (2-digit code) and role/function (3-digit code)
and specialization/activity (3-digit code) that represent your main[strongest?] expertise in the arts.
Other Arts Expertise: Use this section tfor additional areas of arts expertise. You may include more than one
role/function or specialization/activity in the same art field or include more than one art field, role/function, and
specialization/activity.
EXAMPLE: If you are a museum volunteer with extensive knowledge of Southeast Asian art, and you also volunteer at a presenting organization but you
have no specialized arts presenting knowledge, you would complete the Arts Expertise section as shown here:

Arts Expertise

See List of Codes for appropriate numbers.
Field

Role

Specialization

Primary Arts
Expertise

6

0

5

1

0

Other Arts
Expertise

1

0

5

1

0

7

2

5

Work Experience
Use this section to show the various types of organizations that you have worked for:

Select UP TO FIVE types of organizations with which you have had arts experience. These selections may represent both your
primary and other arts experience.
EXAMPLE: If you are a member of an orchestra, are on the board of a local arts agency, and contribute articles to your local newspaper,
you would complete this section as follows:

Work Experience:

5

Please email the completed form and your resume to: [tbd]
National Endowment for the Arts
Office of Panel Operations
Nancy Hanks Center
1100 Pennsylvania Avenue, NW
Washington, DC 20506-0001
Reporting Burden
The public reporting burden for this collection of information is estimated to average 10 minutes 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 Arts Endowment welcomes any suggestions that you might have on improving the panelist profile form and
making it as easy to use as possible. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to Office of Guidelines & Panel Operations, Room 620, National Endowment for the Arts,
Nancy Hanks Center, 1100 Pennsylvania Avenue, NW, Washington, DC 20506-0001. Note; Applicants are not required to respond to the
collection of information unless it displays a currently valid Office of Management and Budget (OMB) control number.

OMB No. 3135-0098 Exp. 8/31/2012
Privacy Act
The following notice is furnished in accordance with the Privacy Act of 1974,
5 U.S.C. 552a:

This information is solicited under the authority of the National Foundation on the Arts and the Humanities Act, 20 U.S.C. 951
et seq. and is used to select persons to participate in the Arts Endowment’s application review process. Disclosure of this
information may be made to members of Congress and to the general public, upon request in accordance with the Freedom of
Information Act (5 U.S. C. 552). Personal biographical data including home address, home telephone number, and social
security number will not be released and is exempt from disclosure under FOIA exemption (b)(6).
Equal Opportunity

Arts Endowment programs do not discriminate on the basis of race, color, national origin, sex, disability, or age. For further
information, write to Director, Civil Rights Division, National Endowment for the Arts, Washington, DC 20506-0001.

National Endowment for the Arts
Office of Panel Operations
Nancy Hanks Center
1100 Pennsylvania Avenue, NW
6

Washington, DC 20506-0001
OMB No. 3135-0098
Exp. 8/31/12
LIST OF CODES

5
10
20
25
30
35
40
45
50

Discipline/Field
ARTS ADMINISTRATION
55 MEDIA
ARTS PRESENTING
60 MUSEUM
DANCE
65 MUSIC
DESIGN
85 MUSICAL THEATER
EDUCATION
70 OPERA
FOLK & TRADITIONAL
ARTS
90 RESEARCH
INTERDISCIPLINARY ARTS
75 THEATER
INTERNATIONAL
ACTIVITIES
80 VISUAL ARTS
LITERATURE

Role/Function
5 Accompanist
195 Designer
10 Actor
196 Developer
10 Actor
200 Director
15 Administrator/Manager
210 Dramaturg/Literary Manager
20 Advocacy Group Member
215 Editor
44 Anthropologist
216 Education Director
30 Architect
226 Education Staff
25 Architectural Designer (non-lic.)
230 Educator
35 Archivist/Librarian
235 Engineer
45 Artist
236 Ethnomusicologist
50 Artist in Residence
426 Evaluator
55 Artist Representative
240 Executive Director/President
60 Artistic Director/Staff
245 Facilities Manager
70 Arts Consultant
255 Film/Video Editor/Technician
71 Arts Patron
250 Filmmaker/Videomaker
75 Assistant/Deputy Director
256 Folklorist
80 Ballet Master/Mistress
260 Former Board Member
85 Board Member/Trustee
265 Former Staff Member
90 Book Distributor
231 General Director
100 Booking Agent
266 Graphic Designer
105 Bookstore Owner/Staff
270 Installation Designer
110 Choreographer
275 Instrumentalist
115 Collector
271 Internet Art Curator
120 Company Manager
280 Keyboardist
125 Composer/Arranger
285 Legislator
131 Digital
290 Librarian
135 Concert Manager
295 Librettist
140 Conductor
300 Linguist
145 Conservator
305 Literary Agent
150 Consultant
310 Literary Programmer
155 Contract Employee
530 Lyricist
7

160
161
170
175
180
185
190
335
340
345
350
355
365
370
375
380
385
390
395
400
405
410
415
420
425
430
430
435
436

Coordinator
Community Volunteer
Critic
Curator
Curator/Programmer
Curriculum Development Specialist
Dancer
Patron
Patron/Collector
Performer
Planner
Playwright
Presenter
Preservationist
Printer
Producer
Program Annotator
Program Director/Staff
Publications Director/Staff
Publisher
Puppeteer
Record Producer
Recording Engineer
Registrar/Collections Manager
Researcher
Scholar
Scholar/Art Historian
School Board Member
School Counselor/Psychologist

740
735
20
25

20th

30
525
40
50
35
36
55
60
775
65

311
315
320
325
330
272
331
440
445
431
450
455
460
465
470
535
476
480
475
485
490
130
495
500
540
515
510
525

Managing Director
Media Artist
Mime
Musical Director
Notator
On-line Archivist
Parent
School Principal/Assistant Principal
School Superintendent
Singer
Solo Performer
Sound Artist
Staff
Stage Director
Stage Manager
Storyteller
Student
Teaching Artist
School Teacher/Arts Specialist
Technical Director
Technician
Technology Specialist
Translator
Union Rep/Official
Visual Artist
Vocalist
Volunteer
Writer

Specialization/Activity
Century Art: post-1945
115 Community Development
th
20 Century Art: pre-1945
120 Digital Arts
Alternative Spaces
125 Conceptual Art
American Art
135 Conservation: Objects
Ancient Art/Archaeology:
Mediterranean
140 Conservation: Paintings
Ancient Art/Archaeology: New
World
750 Conservation: Scientist
Animation
745 Conservation: Textiles
Architecture
130 Conservation: Works on Paper
Art of Africa, Oceania, & the
Americas
780 Contemporary
Artist Communities
145 Contemporary Art
Artists Books
150 Crafts
Arts
155 Crafts: Clay
Arts Center
160 Crafts: Fiber
Asian Art
165 Crafts: General
8

61 Assessment
Audience
75 Demographics/Development
80 Audio Art
601 Audio/Radio
85 Ballet
90 Board Development
91 Broadcast
95 Cable
100 Chamber
105 Choral
790 Circus
110 Classical
110 Classical
230 Distribution
235 Documentary
240 Drawing
240 Drawings & Prints

170 Crafts: Glass

245 Early Music
226 Early Opera (Baroque)
710 East Asian Art

175
180
185
190
195
200
201
210
215
220
225
612
425
435
440
455
460
465
470
480

250 Education
785 Educational Institution
246 Electronic Music

490
495
500

251
255
260
265
275
280
280
285

Elementary
Environmental Design
Essays
Ethnomusicology
European Art
Exhibitions
Exhibitions
Experimental

505
800
805
510
515
496
645
521

290
755
295
300
305
770
310
315
325
330
715
335

Facility Management/Planning
Fashion and Costume Design
Festivals
Fiction
Film
Film/Video
Financial Management
Folk Arts
Folk/Traditional
Fundraising
Generalist
Governance

520
760
521
535
540
545
550
555
560
561
570
565

Crafts: Metals
Crafts: Paper
Crafts: Wood
Creative Nonfiction
Cultural Anthropology
Cultural Exchange
Cultural Studies
Curriculum Development
Dance
Decorative Arts
Disability Access
Distance Learning
Marketing/Public & Press Relations
Modern/Contemporary
Movement Theater
Music
Musical Theater
Musicology
Narrative
Native American Art
New American Work: Musical
Theater
New American Work: Opera
New Music
New Plays/Playwright
Development
New Work: Musical Theater
New Work: Opera
Non-arts
Opera
Opera for Young Audiences
Orchestral/Symphonic
Organizational Partnerships
Organizational/Institutional
Development
Other Genres
Outdoor Drama
Painting
Performance
Performance Poetry
Performing Arts
Photography
Poetry
Post-secondary
Pre-kindergarten/Early Childhood
Preservation
9

340
345
565
355
360
365
370
375
380
381
385
390
395
400
405
410
720
411
415
420
655
660
670
665
675
680
685
695
700
701
765
766
611
730
705
525

Grants Management
Graphic Design
Historic Preservation
History
Individual Artist Support
Industrial/Product Design
Information Services
Inner City
Installation
Instructional Design & Development
Interactive Arts
Interdisciplinary/Performance Art
Interior Design
International Arts
Jazz
Landscape Architecture
Latin American/Caribbean Art
Lighting Design
Literature
Long-Range Planning
Teaching/Staff Development
Television
Theater for Young Audiences
Theater
Traditional Musical Theater
Traditional Opera
Training
Urban Design/Planning
Video
Video Games
Visual Artists’ Organizations
Visual Arts
Website Design/Development
Western Asian Art
World Music
Writer

575
501
574
576
580
585
590
595
600
605
610
615
616
620
625
630
725
635
640
650

Printmaking
Professional Development
Professional/Staff Development
Program Evaluation
Public Art
Public Broadcasting
Publications
Puppetry
Radio
Recording Production
Rural
Sculpture
Secondary
Site Specific Work
Solo Recitalist
Sound
Southeast Asian Art
Space Planning
Storytelling/Oral History
Tap

35
10
475
15
70
12
9
11
801
720
350
430
485
484
449
530

Cultural Specializations
African
African-American
Alaskan Native
Anglo-American
Asian
Asian-American
European
European-American
Intercultural
Latin American/Caribbean
Latino-American
Middle Eastern
Native American
Native Cultures
North American
Pacific Islands/Oceania

10