No Form Number LFPP Peer Reviewer & Qualifications Form

OMB 0581-0287

Peer Reviewer Application and Qualification Form
For Farmers Market and Local Food Promotion Program
Complete the information below to indicate your qualifications to review FMPP/LFPP proposals. The
form must include a copy of your résumé with all employment and volunteer locations. Email
completed form and résumé to [email protected] and indicate in the subject line if
you are applying to be an LFPP or FMPP Reviewer. For more information about the grant programs,
visit http://www.ams.usda.gov/AMSgrants.
Last Name:
Email:
Phone:
Street Address:
City:

First Name:
Fax:
State:

Zip Code:

Employer Name:
Employer Type (mark as many as appropriate):
Federal Employee
Private Sector Employee
State Employee
Farmer/Producer/Rancher
Tribal Government
CSA Employee
Local Government
Retired/Volunteer
Other (Please specify) :
Expertise (mark as many as appropriate):
Grant Writer
WIC
Financial/Budget
SFMNP
Nutrition
EBT
Architecture/Engineering
CSA Operator
Farmers Market
SNAP
Farmers Market Manager
Agircultural Cooperative
Educator/Academia
Roadside Stand Operator
Technical Assistance
Technical Assistance Business
Marketing
Planning
Technical Assistance Other
(please specify) :
Other (please specify) :

Nonprofit Employee
Public Benefit Corp
Economic Development
Corp

Aggregator
Distributor
Direct Marketing
Agri-Tourism
Processor
Food Banks
Environmental
Agricultural Production

OMB 0581-0287
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information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0581- -0287. The time
required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching
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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
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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.