Today's date
Name
Street
City, State, Zip
Your day phone number
Evening phone number
e-mail

How did you hear about the Wildacres Residency Program?

Have you previously participated in a residency program? yes or no

If so, please describe where and when.

The residency program will begin in May and continue through October with one-week sessions beginning on Mondays and ending on Sundays. Please indicate four dates you could be a resident at Wildacres. List in order of preference starting with your first choice:
First choice
Second choice
Third choice
Fourth choice

Please give a brief description about who you are and about your work and interests.

What specific project would you be working on at Wildacres?

Why do you feel that spending a week at Wildacres would assist and benefit you in the progress or completion of this project?

Please click on this button to submit your application: