residencies 2007 - Cover sheet for application

Residencies in Asia 2007

Applicant Details

Category Please select one only	Arts Management					Literature
	Performing Arts					Visual Arts/Craft
Title:	Mr	Ms	Dr	Prof	Other
First Name:
Surname:
Year of Birth:

Address:
Suburb:
State:
Postcode:
Phone:
Fax:
Email:

Art Practice/ Genre:
Language other than English				Yes	No	Specify.................
Do you have Australian citizenship or residency?				Yes	No

Hosts and Countries of Interest:
(In order of preference if applicable)

1. ___________________________________

2. ___________________________________

Please include this form at the front of your application.
Please do not bind or staple your application.

Please return my application material:_________________ (please specify) Supporting documentation (eg. audio/visual material) will only be returned if indicated here and return postage is included.

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