Sample Application Form for Wallace Stegner House Residency

Application form can be downloaded or printed here:

Application.doc or Application.pdf

Name Telephone, home 
Address Telephone, work 
Town / City Fax 
Province Postal Code 
E-mail   
Reference 1
Name Telephone, home 
Address Telephone, work 
Town / City Fax 
Province Postal Code 
E-mail   
Reference 2
Name Telephone, home 
Address Telephone, work 
Town / City Fax 
Province Postal Code 
E-mail   

Preferred Dates for Residency

(October is not open to the regular residency program)


Start Date - End Date

First choice: _______________

Second choice: _____________

Third choice: _______________

Professional Information

  1. Please tell us about yourself and your work. (less than 300 words)
  2. List your major works published, performed or shown, by title, discipline and date.
  3. List any awards applicable
  4. List any professional development you have taken part in (courses, classes, workshops)
  5. Why do you wish to stay at the Stegner House? (less than 300 words)
  6. Please tell us how you heard about the Stegner House.