Expression of Interest Form

Please type on this form or write clearly in black ink.

OPEN CHOREOGRAPHY RESIDENCIES

Summer 2017

Completed applications should be sent to by

12 noon on 12 June 2017.

Personal details:

Name:
Address:
Telephone (day):
Telephone (evening):
Email:
Social Media/Website:
Names of performers, collaborators or others involved:

Your proposal:

Short statement about your artistic practice and links to previous work

(no more than 250 words excluding links)

Please describe how you intended to spend your time at Siobhan Davies Dance. We are interested in finding out more about your artistic ideas, and, where relevant, what stage your project is at and any partners who support it.

(no more than 300 words please)

Please tell us why you think you would benefit from spending time at Siobhan Davies Studios. What particular kind of support do you think you would need from us? How would this residency impact your work?

(no more than 300 words please)

Please tell us how you think you would engage the public with your residency

(no more than 100 words please)

Residency Requirements

Preferred dates in residence (please indicate all possibilities July 10 – Sept 10, 2017):

Have you or will you apply for funding for the activity you are proposing to develop while in residence? Yes / No

If yes, what sources?

When are you planning to submit your application/s?

Is your residency dependent on funding? ie will you use the space if you are unsuccesful? Yes / No

Do you have any particular requirements in terms of equipment or support for access needs?

Signature:
Date:

SIOBHAN DAVIES DANCE - EQUAL OPPORTUNITIES MONITORING FORM

Opportunity applied for:

Open Choreography Residency

How would you describe your ethnic origin?

These codes have been devised by the Government’s Census of Population and are recommended by the Home Office.Choose ONE section from A to E, then tick the appropriate box to indicate your cultural background:

SECTION A: WHITE

( )BRITISH

( )IRISH

( )ANY OTHER WHITE BACKGROUND, PLEASE WRITE IN ______

SECTION B: MIXED

( )WHITE AND BLACK CARIBBEAN

( )WHITE AND BLACK AFRICAN

( )WHITE AND ASIAN

( )ANY OTHER MIXED BACKGROUND, PLEASE WRITE IN ______

SECTION C: ASIAN OR ASIAN BRITISH

( )INDIAN

( )PAKISTANI

( )BANGLADESHI

( )ANY OTHER ASIAN BACKGROUND, PLEASE WRITE IN ______

SECTION D: BLACK OR BLACK BRITISH

( )CARIBBEAN

( )AFRICAN

( )ANY OTHER BLACK BACKGROUND, PLEASE WRITE IN ______

SECTION E: CHINESE OR OTHER ETHNIC GROUP

( )CHINESE

( )ANY OTHER ETHNIC GROUP, PLEASE WRITE IN

Are you?
Female( )Male( )

Do you consider yourself disabled?
Yes ( )No( )

Are you registered disabled?
Yes( )No( )

What is your year of birth?