NEA Panelist Profile Data Collection Form

NEA Panelist
Profile Information
The following information is collected to set up your panelist profile in the REACH system.
Items with an asterisk (*) are required.
Please note that individuals are engaged as Special Government Employees while they serve on
a panel. As such, panelists must be United States Citizens or Permanent Residents, also known
as “green card” holders. All panelists must have an account with a U.S. bank or financial
institution in order to be paid. If you have any questions about these requirements please reach
out to your NEA staff contact before filling out this form.

Legal Name and Contact Information
Legal Name
First*:
Middle:
Last*:
Preferred Name:
City, State* (home):
Primary Email*:
Current Primary Occupation
Job Title*:
Employer*:
City, State* (work):
Categories
Are you a federally registered lobbyist?

Yes

No

The NEA’s enabling legislation requires panels to be geographically, racially, and ethnically
diverse, so we ask for information to comply with this statute. The classifications are prescribed
by the federal government’s Office of Management and Budget for federal reporting and
statistical activities. They do not determine eligibility for participation on panels.

OMB No. 3135-0098 Exp. 8/31/2024

NEA Panelist
Profile Information
Ethnicity (optional):
Hispanic or Latina/o
Not Hispanic or Latina/o
Race (optional; you may choose more than one):
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Sex (optional):
Female
Male
Biography
Provide a brief biography (required) that is no more than 750 characters, including
spaces. Include your current job title or occupation and most significant and relevant
work in the arts; honors, awards, publications, degrees, or other recognitions; board or
other memberships; and any relevant international activities.

OMB No. 3135-0098 Exp. 8/31/2024

NEA Panelist
Profile Information
Privacy Act
The following notice is furnished in accordance with the Privacy Act of 1974, 5 U.S.C. 552a:
This information is solicited under the authority of the National Foundation on the Arts and the
Humanities Act, 20 U.S.C. 951 et seq. and is used to select persons to participate in the National
Endowment for the Arts’ application review process. Disclosure of this information may be
made to members of Congress and to the general public, upon request in accordance with the
Freedom of Information Act (5 U.S. C. 552). Personal biographical data including home address,
home telephone number, and social security number will not be released and is exempt from
disclosure under FOIA exemption (b)(6).

Paperwork Reduction Act Statement
The public reporting burden for this collection of information is estimated to average 10
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. Note: You are not required to respond to the collection of
information unless it displays a currently valid Office of Management and Budget (OMB) control
number.
OMB No. 3135-0098 Exp. 8/31/2024

OMB No. 3135-0098 Exp. 8/31/2024