<p> Tyrone Guthrie Bursary Two Week Residency at The Tyrone Guthrie Centre at Annaghmakerrig</p><p>Application form 2016 Please refer to the guidance notes when completing this form</p><p> Write “not applicable” if a section does not apply to you.  Please use capital letters if using your own handwriting.  If the form is not fully completed and all relevant enclosures attached by the deadline for the Award, your application will be invalid.</p><p>NAME…………………………………………………. </p><p>DISCIPLINE………………………………………………</p><p>PROFESSIONAL NAME IF DIFFERENT …………………………………………………………</p><p>DATE OF BIRTH ………………………………...... </p><p>ADDRESS ………………………………………………………………………………………</p><p>……………………………………………………………………………………………………</p><p>TELEPHONE ………………………………………… </p><p>EMAIL ………………………………………………………...</p><p>1. What is your art discipline? (please ü)</p><p>Architecture Disability Arts Music- jazz Community Arts Drama Music-classical Crafts Literature Music-rock/pop Film Public Art Opera Traditional Arts Dance Visual Arts Other (please specify) ……………………………………………. 2. Have you been to the Tyrone Guthrie Centre before? Yes/No</p><p>If yes, please specify ……………………………………………………………………………………..</p><p>3. List your most important publications/exhibitions/performances of the last three years, with dates and venues:(Continue on a separate sheet if necessary) </p><p>4. Description of what will be worked on at the centre: (Continue on a separate sheet if necessary) 5. SUPPORT MATERIAL</p><p>Please submit a CV and supporting materials relevant to your art discipline. Your application will not be valid without them. </p><p>Images are to be submitted by email or hard-copy photographs only as we are unable to accept CDs or memory sticks to download images. </p><p>Images are to be in jpeg format, no larger than 1MB each and emailed to: [email protected]</p><p>Indicate below what materials, and how many you are submitting. </p><p>Materials Number CV Emailed Images Photographs Publications Videos Reviews Audio Recordings Catalogues Scripts Scores</p><p>Other (please specify) ……………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………… Any additional information you wish to add would be welcome</p><p>6. Name, address and phone number of two independent referees who have knowledge of your work and your art discipline. </p><p>Referee(one) Referee(two)</p><p>Name______Name______</p><p>Address______Address______</p><p>______</p><p>______</p><p>Tel: ______Tel:______7. APPLICANT’S STATEMENT</p><p>I have completed all relevant sections of this application form and confirm that all information provided, and any material submitted in support of the application, is truthful and accurate. I undertake to inform Ards and North Down Borough Council at once if any changes in circumstances require the application or supporting material to be amended and will complete an Evaluation Form as requested. </p><p>Signed: ______(applicant)</p><p>Date: ______</p><p>Application deadline is 12 noon on Wednesday 16 March 2016</p><p>Late applications will not be accepted.</p><p>Have you completed the referee section of the form?  Have you included evidence of your art discipline?  Have you supplied a CV? </p><p>COMPLETED APPLICATIONS</p><p>Return by email to: [email protected]</p><p>Or by post to: Ards Arts Centre l Conway Square Newtownards BT23 4NP</p><p>Enquiries Amy McKelvey: [email protected] Patricia Hamilton: [email protected] </p><p>FOR OFFICE USE ONLY</p><p>CHECK LIST Application reference Date received Date forwarded</p>