Peer Panel Participant Survey
RequiredRequired Question(s)
On behalf of the City of Austin, and for statistical purposes only, the Cultural Arts Division invites individuals interested in serving on Cultural Arts Funding Program or Art in Public Places program peer panels to provide self-identified demographic information. Submission of this information is voluntary, and refusal to provide it will not subject the potential peer panelist to any adverse treatment.  The information will be kept confidential and may only be used in accordance with the provisions of applicable laws and regulations.  When reported, data will not identify any specific individual.
 
Required 1.
Please enter the information indicated below.

First Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Required 2.

What is your gender?  


Female
Male
I choose not to disclose this information
Other  
Required 3.
What is your race/ethnicity?  Please mark all that apply:
American Indian or Alaska Native: a person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.
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.
Hispanic: a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
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.
Other
Not Disclosed
Other  
Required 4.

Are you a Veteran?

Yes
No
I choose not to disclose this information
Required 5.
What is your profession?
 

50 characters left.
Required 6.

Please describe your Education background. What degree(s) do you hold if any?

 

350 characters left.
Required 7.

Please describe any special Training or Certifications that you have.

 

350 characters left.
Required 8.

Please tell us about any professional affiliations that you may have.

 

350 characters left.
Required 9.

Please tell us more about your professional expertise. Please select all that apply.

Dance
Design Arts
Film/TV
Gaming/Digital Media
Humanities
Interdisciplinary
Literature
Multi-Disciplinary
Music
Non-Arts/Humanities
Opera/Musical Theatre
Photography
Theatre
Traditional Arts
Visual Arts
Other  
Required 10.

Tell us more about your professional experience. Select all that apply.

Advertise / Market / Promo
Arts Administration
Arts and Humanities
Arts and Technology
Arts Cultural Fair / Festival Mgt
Arts / Cultural Research
Arts Education
Arts Organizational Develop.
Capital Improvements / Construction
Collaborative Programs / Partnerships
Community Program Development
Curriculum Development
Development Fundraising
Disability Programs
Publish Historical Programs
Touring / Presenting
Youth Programs
Other  
Required 11.
Do you plan to apply for Cultural Funding? Please list the funding program(s) (OS, PSI, PSII, PSIII, CB, CI, CHFP, or CEP) and the artistic discipline in which you intend to apply. 
Yes
No
  • Comment:

  • 500 characters left.
Required 12.

Are you aware of any current conflicts of interest? Are you affiliated with another individual artist, unincorporated group or organization that may also be applying for funding? If yes, please provide the name(s) of the groups/individuals in the comment box below.

Yes
No
  • Comment:

  • 500 characters left.
Required 13.

Have you previously served as peer review panelist? If you have, please tell us which panels you have previously served on.

Yes
No
  • Comment:

  • 500 characters left.
Required 14.

Have you participated or served on any of the following? Select all that apply. If none of the responses apply 

AIPP Commissioned Artist
AIPP Panelist
Arts Commissioner
Austin's New Year Artist or Fan Fest Artist
Creative Ambassador
Cultural Funding Recipient
FACES of Austin Artist
People's Gallery Artist
People's Gallery Juror
None
Required 15.

Please provide a brief bio.

 

1000 characters left.