Coutts Centre Artist Residency Application Form
Personal Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
How did you hear about this residency?
Residency Information
Preferred length of stay
*
3 days
7 days
14 days
28 days
Other
My preferred residency period (eg: Oct 4-Oct 6, 2022). Please ensure you select a date range a minimum of 30 days from the date of your application.
*
1st Choice
*
2nd Choice
Cover Letter
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Introduce yourself and your creative practice (.doc/.pdf format)
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Proposal Statement
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A one-page statement that outlines what you hope to achieve during your residency (.doc/,pdf format)
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Curriculum Vitae
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A CV detailing your professional practice (.doc/.pdf format)
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Support Materials
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3-5 images or writings (.jpg/.doc/.pdf format)
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By checking this box, I acknowledge have read and understand the residency program information and to the best of my knowledge the information I have supplied is true and accurate.
*
I agree
Coutts Centre are committed to follow any current COVID restrictions. By checking this box I agree to comply with any current restrictions or mandates that are in place.
*
I agree
Please verify that you are human
*
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