Residency Application

Applicant Mailing Address (if different from home address)

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

To

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 Email

Website

2nd Reference Name and Relationship *

Applicant Home Address *

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.

Artistic Bio: Enter a brief profile (100 words or less) written in third person describing your work and accomplishments, and your website. If you are a returning resident, you may update your bio.

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.

Applicant Work Phone

Applicant Cell Phone *

EMERGENCY CONTACT: Name and Relationship *

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

TYPE OF APPLICATION *

1st Time Applicant

Returning Fellow

PERSONAL INFORMATION: Applicant Name *

EMERGENCY CONTACT: Email

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

Approximate Number of Weeks Requested

Upload CV or Resume

3. How did you learn about Dorland? *

DATE OF APPLICATION *

1st Reference Name and Relationship *

EMERGENCY CONTACT: Address

*Race/Ethnic Background

*Gender

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

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

To

Upload a headshot photo.

Applicant Home Phone *

EMERGENCY CONTACT: Home Phone

Upload Work Sample

Your Birth Date

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

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

Applicant Preferred Email

Check here to receive email updates

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.” *

2nd Reference Address

Applicant Alternate Email (optional)

ARTISTIC INFORMATION: Main Area of Artistic Work

Date of Signature *

EMERGENCY CONTACT: Work Phone

1st Reference Address

Upload Work Sample

Your media or genre

Upload Work Sample

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

To

EMERGENCY CONTACT: Cell Phone *

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

Other needs