VISUAL ARTS FELLOWSHIP
APPLICATION FORM

1. Full Name___________________________________________________________________________
(please underline surname)

2. Date of Birth_____________________ 3. Nationality _________________

4. Address (for correspondence)____________________________________________________________

______________________________________________________________________________________

Tel no: _______________________ Fax no:_____________________ Email:________________________

5. Degrees______________________________________________________________________________

6. Present Appointment ___________________________________________________________________

7. Period of time it is proposed to spend in Australia _____________________________________________
(give dates if possible)

8. Itinerary Proposed ____________________________________________________________________

_______________________________________________________________________________________

9. Do you have any other institutional financial support? (Please give details)

_______________________________________________________________________________________

10. Amount Required:

Return air fare (Fellows are expected to get the cheapest possible fare)___________________
Contribution to subsistence____________________
Travel within Australia (if appropriate)___________________

TOTAL___________________

11. Three Referees
Please complete the attached 'reference request forms' and send the whole form to three referees (note deadline for receipt of references is 4 June). List the names and addresses of your referees below:

a) _____________________________________________________________________________________
_______________________________________________________________________________________

b) _____________________________________________________________________________________
_______________________________________________________________________________________

c) _____________________________________________________________________________________
_______________________________________________________________________________________

12. Give on separate sheets:

  1. CV with details of qualifications and previous appointments;
  2. Outline of proposed project;
  3. Up to six slides or other supporting material.

Signature __________________________________________Date ___________________________

Return completed form and attachments to the Secretary, Sir Robert Menzies Centre for Australian Studies not later than 4 June 1999.

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