NOMINATION FORM 2017

Nomination form

Name and surname of nominee
Creative field
Contact details of nominee
Postal address:
Telephone number: / Mobile number:
Email:
ID card number of nominee
Bio note of the nominee
Name and surname of nominator
Contact details of nominator
Postal address:
Telephone number: / Mobile number:
Email:
Name and surname of endorser 1
Contact details of endorser 1
Postal address:
Telephone number: / Mobile number:
Email:
Name and surname of endorser 2
Contact details of endorser 2
Postal address:
Telephone number: / Mobile number:
Email:
Name and surname of endorser 3
Contact details of endorser 3
Postal address:
Telephone number: / Mobile number:
Email:
Motivation behind the nomination
Why should they be chosen for the Programme? > pitch
Suggested Maximum: 150 words
What are the nominee’s goals and dreams for the next three years?
Suggested Maximum: 150 words
Name and surname of proposed local mentor
Reason for wanting to work with the proposed mentor

CHECKLIST

Tick the following boxes to make sure you have included all relevant materials with your nomination:

 Video pitch, including:

-  A taster of the nominee’s creative proficiency

-  The nominee’s goals and dreams for the next three years

-  Why the nominee should be chosen for the programme

 Portfolio / links

 Curriculum vitae / bio note (a short paragraph about the creative, their accomplishments and career achievements, the key themes of the creative work)

 Copy of ID card of nominee

 Other relevant material (optional)

Nominator
(Name and surname) / Date / Signature

By signing this declaration I confirm that, to my knowledge, all the information contained in this application form and its annexes is correct.

By signing this declaration I confirm that I have read the Programme Guidelines and Regulations and that I accept the Programme’s conditions and process as stipulated in that same document.

The nomination, which must contain all the required material, must reach Arts Council Malta by the deadline of Thursday 28th September 2017 at 12.00pm. You can submit your nomination form by email to

On the day of the deadline, nominations will only be accepted until noon (12:00). Nominations that reach the Council after the deadline will not be accepted.

Any queries in connection with the above can be sent by email to: or by phone on 2339 7020.

FOR OFFICE USE ONLY
Date of receipt: Nomination Number:

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