Sample Application Form for Wallace Stegner House Residency Name ____________________________________________ Address _________________________________________ Town/City _______________________________________ Telephone - home ________________________________ Telephone - work ________________________________ Fax _____________________________________________ Province ________________________________________ Postal Code _____________________________________ E-mail __________________________________________ References 1.Name __________________________________________ Telephone - home ________________________________ Telephone - work ________________________________ Address _________________________________________ Town/City _______________________________________ Fax _____________________________________________ Province _________ Postal Code ___________________ E-Mail ___________________________________________ References 2.Name__________________________________________ Telephone - home ________________________________ Telephone - work ________________________________ Address _________________________________________ Town/City _______________________________________ Fax _____________________________________________ Province _________ Postal Code ___________________ E-Mail __________________________________________ Preferred Dates for Residency (October is not open to the regular residency program) Start Date End Date First choice _____________________________________ Second choice ___________________________________ Third choice _____________________________________ Professional Information 1. Please tell us about yourself and your work. ( less than 300 words) 2. List your major works published, performed or shown by title, discipline and date. 3. List any awards applicable. 4. List any professional development you have taken part in ( courses, classes, workshops) 5. Why do you wish to stay at the Stegner House? (less than 300 words) Download Application as a word document Application.doc or a pdf file Application.pdf To Contact us click here