First Name *
Last Name *
Street Address *
City *
State *
Zip Code *
County of residence
- None - Bucks Chester Delaware Montgomery Philadelphia
Organization/Company *
Title/Occupation *
Mobile phone number *
Email address *
Entry to Program Stream funding is available for non-profit or fiscally-sponsored arts organizations with budgets under $200,000. To your knowledge, do you have any current conflicts of interest with organizations that might apply for this funding? (Conflicts of interest might include a role as a staff member, board member, consultant, or close working partnership).
Panel meetings will be held in Spring 2022, exact dates are to be determined. Please indicate below any dates in March or April 2022 that you know are unavailable. Once we have confirmed dates, we will confirm your availability.
We have not yet determined if the 2022 panel meetings will be held virtually or in-person. Please indicate your preferences/comfortability below (CTRL + CLICK to multi-select) *
I am comfortable with in-person meetings, if the number of people is limited. I am comfortable with in-person meetings, if masks are required. I am comfortable with in-person meetings, if all panelists are vaccinated. I am comfortable with in-person meetings, if all panelists are vaccinated AND masks are required. I am not comfortable with any in-person meetings.
The following question is optional to answer. Are you currently fully vaccinated against COVID-19?
- None - Yes No I prefer not to answer
Panelist Information
