Coutts Centre Artist Residency Application Form

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
Emergency Contact Name
Emergency Contact Phone
Please enter a valid phone number.
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

Introduce yourself and your creative practice (.doc/.pdf format)
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Proposal Statement

A one-page statement that outlines what you hope to achieve during your residency (.doc/,pdf format)
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Curriculum Vitae

A CV detailing your professional practice (.doc/.pdf format)
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Support Materials

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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Personal Information