IOLTA Grant Advisory Committee Volunteer Response Form

Please volunteer to serve on a Grant Advisory Committee for the upcoming IOLTA Grants Program review. To be considered for committee appointment, please submit this form no later than Friday, March 4, 2011. If you have any questions, please contact Elizabeth Lynch.

IMPORTANT: You MUST be an MBF Fellow to serve on a Grant Advisory Committee.

Volunteer Response Form Name: Firm: Address: City, Zip: County: Phone: Fax: E-mail:

Please check all that apply:

Please consider me for a Regional Committee. (Site visit to applicant required—one meeting in region)
I am able to review more than 2 applications (Regional reviewers only)
Please consider me for a Subject Committee (No site visits required—one meeting in Boston)
I served on a committee last year
I volunteered last year and was not selected. (We will make every effort to place you on a committee this year)

I would like to review grant applications from the following County(ies):

I have expertise and/or interest in projects on the following Topic(s):

To avoid any conflicts of interest, I have listed below organizations with which I or my immediate family have a relationship. (You will still be considered for a committee, but will be required to recuse yourself from any discussions on an organization with which you are associated).