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APPLICATION FORM |
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| First name: | Surname: |
| Education and school/university: |
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| Date of Birth: | Nationality: |
| Male/Female: | |
| Education: | |
| Language profiancy: | |
| Address: | Phone: |
| City: | Email: |
| Country: | URL: |
| Requested period of residence. Please see 'How to apply': | |
| Field(s)
of Art: |
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| Project title and a short description: |
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| Community group to work with: |
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| Previous community art practice: |
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Date and signature:
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