Key Personnel Form

This form should be completed by any key personnel involved in the delivery of projects funded under the Regional Museums Grants Program. It confirms your intent to participate in agreement with the terms and conditions. Please ensure that any fees confirmed in this form match the costs outlined in the project budget. Any contact details you provide may be used to clarify or confirm participation by MAGNT and/or the assessment panel.

Project name
Applicant / Applying organisation

Name of key personnel
Home region	☐ Barkly ☐ Big Rivers ☐ Central Australia ☐ Interstate/ International	☐ East Arnhem ☐ Darwin, Palmerston and Litchfield ☐ Top End
Phone
Email
Do you identify as	☐ Aboriginal and/or Torres Strait Islander ☐ CALD (Culturally and Linguistically Diverse) ☐ Person with disability ☐ Person from a remote area ☐ Senior (over 60) ☐ Youth (under 26)
What is your role in this project?	☐ Curator ☐ Producer ☐ Artist / Creative Practitioner ☐ Conservator ☐ Technical Production ☐ Consultant ☐ Board Member ☐ Cultural Advisor ☐ Other: Please specify
What is your involvement?	☐ Paid - Payment $ Enter Amount ☐ Unpaid ☐ In-kind - Value of in-kind $ Enter Amount
I confirm my involvement and fee structure outlined in the form.
Key Personnel Signature	Enter or select date