Residency Application

2nd Reference Address

Cottage Preference (You may check more than one.)

Connors

Horton

Markham

Roripaugh

Zachai

Any

EMERGENCY CONTACT: Address

2nd Reference Name and Relationship *

DATE OF APPLICATION *

Applicant Home Phone

EMERGENCY CONTACT: Cell Phone *

3. How did you learn about Dorland? *

1st Reference Email

Approximate Number of Weeks Requested

Upload Work Sample

Your Work Samples - Writing: 2-3 pdfs only (15 pg or less for total samples); Visual Art: 3 jpgs; Music: 2-3 mp3s

DEMOGRAPHIC INFORMATION: (*Optional) Dorland would appreciate your furnishing demographic information. Providing information is not required; however, knowledge of this information assists Dorland as we measure how successful we are at making programs available to a broad group of applicants. Demographic information is provided to potential funding agencies upon their request.

REFERENCES: List below, the names and addresses of two people in your field who are familiar with your work and who have agreed to supply letters of reference on your behalf. Please ask your references to send or email the letters directly to Dorland, with your name in the subject line or send sealed letters with your application.

PERSONAL INFORMATION: Applicant Name *

Your Birth Date

1st Choice Dates: Arrival (2pm) & Departure (11am)

To

Upload your CV or resume.

Other needs

Applicant Work Phone

2nd Reference Email

If I am accepted you may use my photograph, bio and/or a quote in Dorland Social Media. *

Yes

No

1st Reference Name and Relationship *

EMERGENCY CONTACT: Email

AGREEMENTS “I acknowledge that I have read, understand and agree to abide by all terms, rules and regulations outlined in Dorland’s Residency Application and Instructions and Residency Information and Guidelines.” *

DORLAND PUBLICITY - If I am accepted you may photograph me at work (at an arranged time), or use photos I submit for the sole purpose of marketing Dorland and I agree that you may publish these photos and a quote in print and online, for use in promoting Artist Residencies at Dorland. *

Yes

No

Upload Work Sample

Applicant Alternate Email (optional)

Applicant Preferred Email *

Check here to receive email updates

ARTISTIC INFORMATION: Main Area of Artistic Work

Your media or genre

Artistic Bio-Enter a brief profile (100 words or less) written in third person describing your work and accomplishments, and your preferred website link. This will be featured on our website Residents page.

Applicant Cell Phone *

EMERGENCY CONTACT: Home Phone

Date of Signature *

2. Please list your three most recent professional achievements. *

*Race/Ethnic Background

EMERGENCY CONTACT: Name and Relationship *

Note- If you have a problem with the calendars above, please type in your date choices here:

EMERGENCY CONTACT: Work Phone

4. What other artists’ communities or retreats have you attended?

Upload a headshot photo.

Website

1st Reference Address

1. What do you envision accomplishing during your residency? *

*Gender

Applicant Mailing Address (if different from home address)

Arrival (2pm) & Departure (11am)Arrival & Departure Dates

To

2nd Choice Arrival (2pm) & Departure (11am)

To

Applicant Home Address *

Upload Work Sample