Panelist Nomination
Panelist Nominee
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State
Zip Code
Day Phone
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-
Area Code
Phone Number
Cell
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Area Code
Phone Number
Fax
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Area Code
Phone Number
Email Address
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Website
Has the Nominee previously served on MAC panel(s)
Yes
No
Unknown
If Yes, which panel(s) and what fiscal year(s)
What experience and skills would help you serve as a MAC panelist? Describe your experience as an artist, administrator, teacher, volunteer, business professional. Note in what area of the arts you have expertise and if you have served on a panel or commission in another capacity.
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Attach Nominee Resume'
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Browse Files
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Optional Questions
In order to develop a panel that reflects Missouri's diverse populations, cultures and citizens, MAC is requestion information on the Nominee's back ground. The questions below are optional.
Gender (Choose One)
Female
Male
Do not wish to answer
Age (Choose One)
20-29
30-39
40-49
50-59
60+
Do not wish to answer
Ethnic background
African/African American
Asian/Pacific Islander
Hispanic/Latino/Chicano
Native American/Alaskan Native
White/Not Hispanic
Multicultural (more than one of the above racial/ethnic categories applies)
Do not wish to answer
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