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2. Application Instructions

   Please return this application to the address below
   
   Susan Mong, Culture Division Superintendent, JCPRD
   Email: [email protected] | Phone: (913) 715-2573
   
   8788 Metcalf Avenue, Overland Park, KS 66212
4. Today's Date*
   Today's Date
6. First Name*
7. Last Name*

11. Residence
13. Address*
15. City*
16. State*
17. Zip Code*
19. Phone Number*
20. Cell Number
    If different than other Phone Number
22. Email Address*

26. Employer
28. Employer Name
30. Your Title
32. Employer Address
34. City
35. State
36. Zip Code
38. Phone Number
39. Email Address
41. Type of Business or Organization
42. Primary Service(s) and Area/Population Served
44. Preferred Method of Contact*

    1. Work

    1. Residence

48. Please List Your Board and Committee Experience.
50. Organization
51. Role/Title
52. Dates of Service
    Dates of Service Start Date

    —

    Dates of Service End Date
54. Organization
55. Role/Title
56. Dates of Service
    Dates of Service Start Date

    —

    Dates of Service End Date
58. Organization
59. Role/Title
60. Dates of Service
    Dates of Service Start Date

    —

    Dates of Service End Date
64. Briefly share the reason for your application to the JCPRD public art committee.*
66. How do you feel the JCPRD public art committee would benefit by your involvment?*
68. Skill, experience, and interests*

    Please check all that apply.

    1. Finance, Accounting
    2. Personnel, Human Resources
    3. Administration, Management
    4. Nonprofit Experience
    5. Community Service
    6. Policy Development
    7. Program Evaluation

    1. Public Relations, Communications
    2. Education, Instruction
    3. Special Events
    4. Grant Writing
    5. Fundraising
    6. Outreach, Advocacy
    7. Other (please list below)
70. Other (if checked below)
    Please list additional skills, experience, and areas of interests not mentioned above.
72. Please list any groups, organizations, or businesses that you could serve as a liaison to on behalf of the JCPRD public art committee.
74. What are your goals while serving on this committee and how would you contribute to enhance the visual environment within the county and provide our residents with the opportunity to live with Public Art?
76. Why are you the most qualified to serve on this committee?
78. Please check below before submitting.*

    I have read The Theatre in the Park Advisory Council Charter. I understand the purpose and responsibilities of the council. If selected to serve, I will uphold the purpose and fulfill those responsibilities as a member.

    1. Yes
80. Please tell us anything else you would like to share. (Optional)

82. Thank you for applying!
Leave This Blank:


84. 1. Receive an email copy of this form.
85. Email address

    This field is not part of the form submission.

86. Submit

* indicates a required field