Writer in Residence

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* 1. Contact Details

Name

Address

Address 2

Suburb

State

Postal Code

Email Address

Phone Number

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* 2. Website

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* 3. ABN

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* 4. Do you live in the City of Port Phillip?

Yes

No

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* 5. Do you work in the City of Port Phillip?

Yes

No

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* 6. Are you happy to participate in open studio days for Linden?

Yes

No

Unsure

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* 7. Provide us with a statement about your practice

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* 8. Provide a brief biography about your practice highlighting key achievements

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* 9. How would having a studio at Linden benefit your practice?

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* 10. Do you have a project that you would like to work on whilst in residence at Linden?

No

Yes, I would like work on the following project:

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* 11. How often would you use the studio space?

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* 12. We require the names of 2 professional referees to support this application. Please provide the contact details of a professional referee 1 below

Name

Company

Email Address

Phone Number

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* 13. Please provide the contact details of your professional referee 2 below:

Name

Company

Email Address

Phone Number

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* 14. Do you have a current working with children check?

Yes

No

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* 15. Do you have a current police check?

Yes

No