Fee Office use only CD IF SAINSBURY SCHOLARSHIP IN PAINTING AND SCULPTURE APPLICATIONS SHOULD BE SENT TO THE REGISTRAR, THE BRITISH SCHOOL AT ROME, 10 CARLTON HOUSE TERRACE, LONDON, SW1Y 5AH, TO ARRIVE NO LATER THAN FRIDAY 29 JANUARY 2016. APPLICATIONS SENT BY FAX OR E-MAIL WILL NOT BE ACCEPTED. Please ‘type’ or complete in BLACK ink. Please ensure that the pagination matches the indicators for the end of each page. The form is available as a Word document at www.bsr.ac.uk/awards/fine-arts. You may, if eligible, also apply for the Derek Hill Foundation Scholarship and the Rome Fellowship in Contemporary Art (for which separate applications are required) and pay just one entry fee. 1. Name 3. Tel. E-mail 5. 2. Address 4. Age Date of birth (a) Nationality (b) If you are not a British citizen, give country/countries of residence + dates since 1 January 2011 6. Present Occupation 7. Further and Higher Education (College/University, Dates, Qualifications (with grades)) 8. Exhibitions Give details of exhibitions where your work has been shown publicly other than as part of any courses in question 7. If there is not sufficient space to list all your exhibitions, please limit yourself to selected exhibitions. Do not attach extra sheets. 9. Awards, Prizes and Publications End of page 1 Name 10. Professional Experience 11. Can you speak and/or read Italian? 12. Have you already visited Rome or Italy? Please give details. 13. Where did you hear about the residency? 14. Surname Names, postal addresses, telephone numbers and e-mail addresses of two referees who are familiar with you and your work. 1. 2. Name Address Telephone E-mail 15. Please answer question 15 on page 3. An entry fee is payable. It is your responsibility to ensure that you have read the eligibility criteria carefully: the entry fee is non-refundable. 16. I enclose the entry fee of £25 (in the form of a sterling cheque drawn on a British bank payable to ‘The British School at Rome’) OR I wish to pay by credit or debit card (£25) If you wish to pay by debit or credit card (Visa, MasterCard, Maestro-UK, Debit MasterCard, Visa Debit, American Express, JCB, Diners, Laser, Electron), you may complete the attached form (which will be destroyed once the payment has been taken) or may phone us on 020 7969 5332 to give your card details on Tuesday 2 February. OR 17. I have also applied already for the 2016–17 Derek Hill Foundation Scholarship and/or Rome Fellowship in Contemporary Art (in which case no further entry fee is required) I enclose a CD with work, as detailed on the form on pages 4 and 5 It is anticipated that interviews will be held in London in early March. Candidates will be informed of the precise date when we acknowledge receipt of an application shortly after the closing date. I confirm that, if shortlisted, I shall be available for interview and can cover all my travel and other interview expenses. I confirm that the information given in this application is, to the best of my knowledge, complete and accurate. Submitting this form constitutes your acceptance of all the terms and conditions contained in the announcement of this residency. Signature Date End of page 2 Name 15. Surname Why are you applying for a residency and what do you expect to gain from a period spent in Italy? Please include a brief statement of your intentions after the Scholarship and explain how you would envisage you would contribute to the wider UK artistic community. (The maximum length is 550 words, minimum font size 10pt. Please adapt your proposal to fit the space provided: do not continue overleaf and do not attach extra sheets.) DISABILITY Applicants with special needs are requested to contact the Registrar before submitting their application to discuss their requirements. The British School at Rome is registered under the Data Protection Act 1998 [Registration Number: K0335060] and adheres to the Data Protection Principles. Applicants should be aware that information they provide will be stored in electronic form. It will be provided to those who assess applications and to staff of the BSR, and will be used to compile published lists of award-holders. End of page 3 List of images submitted in support of application for: Sainsbury Scholarship in Painting and Sculpture Name of candidate: ........................................................................................................................................... You should submit fifteen images, eight of which should be of paintings or sculptures, seven of which should be of drawings. You should take note of the aims of this particular Scholarship when you select the images. They should be sent on a CD-Rom with the images saved in RGB JPEG digital file format, at a screen-based resolution of 72 dpi, with ideal dimensions of 1024 × 768 pixels. Please ensure that JPEGS and CD-Rom are PC-compatible. The files should be named as follows: first four letters of your surname, first letter of your first name, number corresponding to the image list (e.g. Gill Clark’s third image — clarg03). Please complete the table below in typescript or, if this is not possible, in block capitals in black ink. Image no. Title of work Height PAINTINGS or SCULPTURES 01 02 03 04 05 06 07 08 Size (in cm) Width Year of completion Medium DRAWINGS 09 10 11 12 13 14 15 No images in excess of this number will be examined. End of page 5 Application for: Sainsbury Scholarship in Painting and Sculpture Please charge the competition entry fee of £25.00 to the following card. Visa/Delta Electron Mastercard American Express Solo/Maestro Name on card: _________________________________________________________________ Card number: __________________________________________________________________ Start date (if given): ____________________________________________________________ Expiry date: _____________________________________________________________________ Issue no. (Solo/Maestro): ______________________________________________________ Card security no. (three digit number from the reverse): ___________________ Billing address: _________________________________________________________________ ____________________________________________________________________________________ E-mail address to which the receipt for the transaction can be sent: ____________________________________________________________________________________ Signature: _____________________________________________ Date: __________________ Please note: all of your card details will be destroyed once the payment has been processed. If you do not wish to send these details on this form, you may phone us on 020 7969 5332 on Tuesday 2 February (10.00–13.00, 14.00–16.30 London time). The British School at Rome Monitoring Form As part of the British School at Rome’s commitment to equal opportunities, the age, gender and ethnic origin of people who apply is monitored. We should be grateful, therefore, if you would complete this form. Any information that you give will remain confidential. The form will be detached from your application, will not form any part of the selection process, and will be used only for the purposes of monitoring. Please do not sign the form or give your name. Thank you for your cooperation. Date of birth (dd/mm/yyyy) Female / Male / Prefer not to say Please show which group best describes your ethnic origin or descent by ticking ONE of the boxes below. The groups are derived from the 2001 census categories, as recommended by ACAS. Asian or Asian British Bangladeshi Any other Asian background, please write in box Indian Pakistani Caribbean Any other Black background, please write in box Black or Black British African Chinese Chinese Any other, please write in box Mixed heritage White and Asian White and Black African White and Black Caribbean Any other mixed background, please write in box White British English Irish Scottish Welsh Any other White background, please write in box Other ethnic group Any other ethnic group, please write in box Decline to specify Do you consider yourself to have a disability? Sainsbury 2016–17 No Yes