Sample Application Form for Wallace Stegner House Residency

You can download the application form here:

Application.doc

 

Name	_______________________________________
Address	_______________________________________
Town / City	_______________________________________
Telephone, home	_______________________________________
Telephone, work	_______________________________________
Fax	_______________________________________
Province	_______________________________________
Postal Code	_______________________________________
E-mail	_______________________________________
Reference 1
Name	_______________________________________
Telephone, home	_______________________________________
Telephone, work	_______________________________________
Address	_______________________________________
Town / City	_______________________________________
Fax	_______________________________________
Province	_______________________________________
Postal Code	_______________________________________
E-mail	_______________________________________
Reference 2
Name	_______________________________________
Telephone, home	_______________________________________
Telephone, work	_______________________________________
Address	_______________________________________
Town / City	_______________________________________
Fax	_______________________________________
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)
6. Please tell us how you heard about the Stegner House.