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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
34. Please state your interest in serving on an Art Selection Committee.*
36. Please share your qualifications that would contribute to a successful public art selection process.*
38. Please tell us anything else you would like to share (Optional).

40. Thank you for your interest!
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42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field