No Form Number LFPP Grant Peer Reviewer Qualifications

Complete the information below. The form must include a copy of your resume with all employment and volunteer locations. Email completed form and resume to [email protected].
Applicant
Last Name:
First Name:
Home State:
Email:
Phone:
Fax:
Address
Street:
City:
State:
Zip Code:
Employment
Employer:
Organization:
Remarks:
Employment/Volunteer (select as many as appropriate)
		Federal Employee		Farmer / Producer / Rancher
		State Employee		CSA Employee
		Tribal Government		Nonprofit Employee
		Local Government		Economic Development Corp
		Private Sector Employee		Public Benefit Corp
		Other (specify below)		Retired / Vounteer (specify below)
Expertise		(select as many as appropriate)
		Grant Writer		Farmers Market
		Agricultural Production / Rancher		Farmers Market Manager
		Nutrition		Roadside Stand Operator
		Architecture/Engineering		CSA Operator
		Financial / Budget		Agricultural Cooperative
		Educator / Academia		Direct Marketing
		WIC		Agri-Tourism
		SFMNP		Processor
		EBT		Aggregator
		SNAP		Distributor
		Environmental		Food Banks
		Technical Assistance - Business Planning		Technical Assistance - Marketing
		Technical Assistance - Other (specify)		Other (specify below)
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0581-New. The time required to complete this information collection is estimated to average 15 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 U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable sex, marital status, or familial status, parental status religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program (not all prohibited bases apply to all programs). Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.