The Corner Dance Lab - Indigenous Residency Scholarship Application Form

Indigenous Residency Scholarship Application Form

Application Deadline - October 4, 2015
Read and follow the instructions carefully prior to submitting your application. You can find the link here. All applicants will be notified on or before 30th October 2015.
Read and Understand the instructions.*

Yes, I have
All correspondence will be generated from the personal information submitted below. So, please use proper spelling, capitalisation and punctuation.
I. Contact details:

Tell us about yourself
Full Name*

PrefixFirst NameMiddle NameLast NameSuffix
Home Address :*

Street Address

Street Address Line 2

CityState / Territory

Post CodeCountry
E-mail :*
Where the confirmation will be send to
Mobile No. :*

Area CodePhone Number
Telephone No. :*

Area CodePhone Number
Birthdate:*

MonthDayYear
Are you an Indigenous Australian artist?

YesNo
Do you require assistance filling out this form?

YesNo
If Yes, relationship to applicant:
Full name of person filling out this form*

PrefixFirst NameMiddle NameLast NameSuffix
Mobile No. :*

Area CodePhone Number
Telephone No. :*

Area CodePhone Number
E-mail :*
Where the confirmation will be send to
II. Dance Experience:
Short biography:*

0/200
I am currently
Dancing as a hobby (non-professional)?

YesNo
If Yes, where?
Studying at a pre-tertiary / tertiary-level dance institution?

YesNo
If Yes, where?
A recent graduate?

YesNo
Course Attended / Attending:
Year of Graduation:
Working indpendently?

YesNo
Working with a company?

YesNo
Name of company:
Have you previously worked with Philip Channells ?

YesNo
Have you previously worked with Gavin Webber?

YesNo
III. Availability:
I am available between Friday 15 - Saturday 23 January 2016 and wish to take part in The Corner Dance Lab

YesNo
IV. Support Letter:
I am providing a letter of support from:*
Their E-mail address:*
Where the confirmation will be send to
Upload support letter

Upload a File

Cancelof
V. Questions:
Q1: What interests you about this opportunity? *

0/150
Q2: Tell us about your current dance practice?*

0/150
Q3: What do you hope to gain from being part of The Corner Dance Lab 2016?*

0/150
V. Choreographic Practice:
During The Corner Dance Lab there will be an opportunity for emerging artists to be mentored through their own choreographic practice. Would you be interested in this opportunity?*

YesNo
If Yes, please discuss your creative process:

0/150
VI. Acceess Requirements:
Preferred method of contact*

EmailMobile / TextTelephoneOther
Comment:
Do you have a disability?*

YesNo
Comment:
I have access requirements*

YesNo
Comment:
I have medical requirements*

YesNo
Comment:
I have dietrary requirements*

YesNo
Comment:
I need transport assistance to Jasper Corner, Federal*

YesNo
If No, please comment:
I would like to discuss my access & transport needs, medical & dietary requirements and any other support needs I have through my preferred method of contact. *

YesNon/a
VII. Scholarship Details
If successful, I understand the $1500 scholarship will be invested in my travel, accommodation and registration costs for The Corner Dance Lab 2016*

Yes
I understand all other expeses will not be covered *

Yes
VIII. Additional information
Any additional information you would like us to know:

0/500
IX. Authorisation and Consent
I have read and understood the information regarding The Corner Dance Lab - Indigenous Residency Scholarship and give my consent to participate and be photographed / videod for promotional purposes. I also consent for contact bewteen Arts Northern Rivers, Dance Integrated Australia and The Farm staff and volunteers to take place.*

Yes
I understand if my application is successful that I need to be avaliable for the duration of The Corner Dance Lab Residency between Friday 15 and Saturday 23 January 2016.*

Yes
I understand that any bullying, sleeping in an undesignated accommodation, failing to co-operate with the artistic process and any other inapproriate behavior deemed to have a negative impact on my or other particpant’s health & well being, Arts Northern Rivers, Dance Integrated Australia and The Farm reserve the right to terminate my scholarship.*

Yes
X. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct at the time of completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:*
Should be Empty:

Indigenous Residency Scholarship Application Form

I. Contact details:

II. Dance Experience:

III. Availability:

IV. Support Letter:

V. Questions:

V. Choreographic Practice:

VI. Acceess Requirements:

VII. Scholarship Details

VIII. Additional information

IX. Authorisation and Consent

X. Applicant's E-Signature