Name ____________________________________________
Address _________________________________________
Town/City _______________________________________
Telephone - home ________________________________
Telephone - work ________________________________
Fax _____________________________________________
Province ________________________________________
Postal Code _____________________________________
E-mail __________________________________________
1.Name __________________________________________
Telephone - home ________________________________
Telephone - work ________________________________
Address _________________________________________
Town/City _______________________________________
Fax _____________________________________________
Province _________ Postal Code ___________________
E-Mail ___________________________________________
2.Name__________________________________________
Telephone - home ________________________________
Telephone - work ________________________________
Address _________________________________________
Town/City _______________________________________
Fax _____________________________________________
Province _________ Postal Code ___________________
E-Mail __________________________________________
(October is not open to the regular residency program)
Start Date End Date
First choice _____________________________________
Second choice ___________________________________
Third choice _____________________________________
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)
