（1）Introduction

This application form and the accompanying guidelines for applicants are for the Aomori Contemporary Art Centre "Artist in Residence program 2012/Autumn." For an explanation of the program details and conditions, please see the APPLICATION GUIDELINES document. Please read and confirm the conditions in this document carefully before filling in this form and applying for our program.

(2)How to apply

To apply, please submit the following documents by the due date.

a. A Completed Application Form. (including a work proposal)

b. A Portrait photograph. (Please attach it to the application form) *the photo should have been taken within the last 6 months.

c. 5 photos of your recent 5 art works (both of prints and digital data (jpeg). Each print should be smaller than A4 or letter size in size. Please choose 1 photo as your outstanding work for the publicity after selection and make it clear with a mark which photo you have chosen. 5

d. Portfolio (A4 size or letter size)

e. Depending on the genre, edited film or music (DVD or CD) must also be submitted (if you need).

　* The Organizer has the right to use the materials submitted by successful applicants for public relations purposes.

【Important】

・Any application which reaches ACAC after the deadline will not be accepted.

・Any application which fails the requirements stated above will not be accepted.

・Submitted items (application form and images) will not be returned to the applicant. If it is important that the materials be returned, please send an envelope with return name and address and a set of international reply coupons or give us your account number of the International transportation company for shipping freight collect.

・Applications via E-mail and Fax will not be accepted.

(3)Deadline for Applications

Applications must reach us by post no later than 25 May, 2012.

(4)Address to submit Application Form

Aomori Contemporary Art Centre

atten: AIR 2012

152-6 Yamazaki, Goshizawa, Aomori, 030-0134, JAPAN

(5) Supplementary Materials

For particulars or requests about the materials please inquire at Aomori Contemporary Art Centre by e-mail or FAX.

acac-air@acac-aomori.jp URL: http://www.acac-aomori.jp　Fax +81-17-764-5201
FORM(1/6)

Please attach your portrait here.

Please type or print clearly in block letters

A. Personal Information

First Name:			Family Name:
Name as recorded in passport (if different from above)
Home Address: Country / Post Code
E-mail
Tel (Home):					Fax (Home):
Contact address (if different from above): Country / Post Code:
Contact phone number: (if different from above):					Fax:
Emergency contact address or phone number
Date of birth:				Age:	Town / City of birth:
year:	/month:	/day:
Male / Female					Nationality:
Please describe your current activities / employment briefly: Place of employment: Occupation / position:
How did you find out about this program?

FORM(2/6)

B. Experience of staying in Japan　

Have you ever visited Japan?

YES NO

If yes, please explain briefly what kind of stay in Japan it was:

Ｃ．Experience of Artist-in-Residence Programs

Have you ever been invited to participate in Artist-in-Residence Programs before?

YES NO

If yes, please explain briefly when and where (city / country) you went, and what kind of programs (the organizer, contents, etc.) they were:

FORM(3/6)

D. Curriculum Vitae and Record of Activities

genre
1　Curriculum Vitae
Year / month	Academic background
２　History of Activities（selected） * Please write your selected exhibitions or activities. If you would like to attach full version’s “History of Activities” that will only be used in the selection process, please do so on a separate sheet s.
year month	History of creative activities, main exhibitions of works, experience of working in residence, etc
Information about your outstanding work for the publication.	title: media:	year: location of exhibition:

FORM(4/6)

E. Artist’s Statement: Please complete your Artist’s Statement within 100 words.

F. Motive for Application: Please state your motive for applying to this program within 150 words.

FORM(5/6)

-- G. Work Proposal –

Please outline your work plan and proposed themes for this program.

FORM(6/6)

-- H. Exchange program Proposal –

Please explain about your plan for the lecture, workshop or communicative/ collaborative project with local people and so on.