2012 Visual Arts Fellowship application form
(Cut and paste into an MS Word doc, print out, complete and return with your entry)
NAME:
ADDRESS:
ZIP:
LEGISLATIVE DISTRICTS: House # ____ Senate #____
PHONE:
E-MAIL
WEB SITE/BLOG
□ My address on the mailing label was wrong.
□ Check here if you enclosed a self-addressed stamped postcard (optional) so we can acknowledge receipt of work.
□ Check here if you would like a one-on-one evaluation session with one of the fellowship jurors on Sunday morning, April 1, at the “CLICK!” conference in Pinedale. There are a limited number of 15-minute slots available. First-come, first served!
Are you registered with the new artist image registry?
□ I have not already registered for the new online AIR, so I understand my images will be retained. I am also enclosing the AIR submission form (obtained by calling the Arts Council or visiting http://wyoarts.state.wy.us./Artists/AIR.aspx).
□ I have already completed forms and submitted images for the new online AIR. I have provided a stamped, self-addressed envelope for the return of my images.
Enclosure checklist
□ Current resume (for promotional use only; resume not reviewed by jurors)
□ Signed entry form
□ List of images on CD/DVD with title, size and media
□ Completed artistic statement
□ AIR application (if not registered with the new, online AIR)
□ Optional acknowledgement postcard
Fellowship application list of images
For each submitted image, please list title, medium, year completed and dimensions (you may use separate sheet)
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
ARTISTIC STATEMENT
On a separate sheet, please provide a brief (100 words or less) artistic statement about your goals and what you hope to accomplish artistically with the work you have submitted.
MATERIALS INCLUDED WITH APPLICATION:
□ CD (10 images) □ DVD (title, date created, total length of work)
MATERIALS RETURN
□ I have included a mailing package with sufficient postage for return of materials.
□ I will pick up my support materials at the Council office after April 2, 2012, or I will make other arrangements by contacting the WAC at 307-777-7742.
I certify that I have been a legal resident of Wyoming Wyoming Wyoming
Signature ___________________________________
Date _______________________________________
