Application Form – Patreon-funded Fogliano Residency 2020 If you are human, leave this field blank.Application Form for Patreon Fogliano 2020 Residency ProgramGuidelinesPlease ensure that you have read all about the program on the program webpage prior to submitting your application. Name *Address *CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabweCityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)American SamoaGuamNorthern Mariana IslandsPuerto RicoUS Minor Outlying IslandsUS Virgin IslandsZip codePhone *Email *Proof of Identity *Please provide proof of Identity - scan of driver's licence, passport or official document. Accepted File formats: png, jpeg, gif, pdf. If you have difficulty in uploading a file, please contact us directly.Type of Application *Regional (British Columbia)National (Canada)InternationalPlease select one onlyLevel of Education CompletedHigh SchoolTechnical / TradesCollege - DiplomaCollege or University - UndergraduateCollege or University - PostgraduateArtist Primary Media/Area of InterestPaintingDrawingSculptureMixed MediaPrintmakingDigital photography or digital mediaCeramicsVideoSoundWritingMusicFilmPerformanceHow did you hear about this program? *AkimboRes ArtisRU Residencies unlimitedArt RabbitArt RubiconTourism GuideBC Arts GuideInstant CoffeeFacebookTwitterInstagrameNewlstterWord of MouthEmergency Contact Name *Emergency Contact Information - address, country, postal codeEmergency Contact Phone Number *Emergency Contact email address *Attachment #1 - Curriculum Vitae (c.v.) or Resume *Accepted File Formats: pdf, doc, docx, txtAttachment #2 - Artist or Writer Statement *Accepted File Formats: pdf, doc, docx, txt Writers: attach a brief description of overarching concerns or themes.Attachement #3 - Statement of Intent for Project *Please be sure to include any special requirements re: equipment, workshop, space, etc. Accepted File Formats: pdf, doc, docx, txtURL to websiteIn lieu of attaching images, please include your website, which includes a portfolio of your work online. Attachment #4 - Artist Portfolio or list of published worksONLY IF YOU DO NOT HAVE A WEBSITE WITH PORTFOLIO - submit between 10 - 20 images of recent work. Please combine the images into only one file, then upload.Do NOT upload a file larger than 54 MB. Accepted file formats are pdf, jpg, gif, png, doc, txt. For video or sound work, include a link to a portfolio of your work online.Attachment #5 - Please attach One (1) Letters of RecommendationMake sure your reference includes letterhead and/or their contact information (phone, e-mail and address.) Also make sure your reference defines their relationship to you. These may be sent directly, separate from this application, to: air@caetani.orgAdditional Attachments - Please supply any additional information that you feel may be pertinent to your applicationAccepted File Formats: pdf, doc, docx, txt, jpg, gif, pngCheck List *C.V. or resumeArtist StatementStatement of Intent for ProjectPortfolio or link to website (preferred) letter of recommendation (or sent separately by the deadline to air@caetani.org)Proof of IdentityPlease ensure that you have provided ALL of this information (letters of recommendation can come later)Applicant's Signature. Please ensure that you have read and understood all the guidelines and requirements for the program you are applying for.I affirm that all information presented is complete, correct and accurate, and that any work presented is the result of my own creative efforts. I have read through the guidelines and conditions and understand my obligations to the Caetani Cultural Centre and the Artist in Residence Program as specified. The information collected on this form will be used solely by the Caetani Cultural Centre Society for the purposes of admission, registration, sponsorships, accommodation, follow-up or program evaluation, research, planning or funding purposes. Please contact us if you wish to be removed from any future mailing lists. If accepted, I agree to conduct myself in a manner that meets with the expectations of all program participants and the Caetani Cultural Centre Society. By submitting this form I agree to the above conditions. Captcha *reCAPTCHA is required.Submit