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Wallace Stegner House application form.

Application form can be downloaded or printed here:

Application.doc or Application.pdf

Name _____________________________________
E-mail _____________________________________

References
1. Name____________________________________
E-Mail _____________________________________

References
2. Name____________________________________
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.