www.studioupstairs.org.uk
Units 1 & 2 Albion Dockside Estate
Hanover Place
Bristol
BS1 6UT
0117 930 0314
bristolstudio@studioupstairs.org.uk
Leading Creative Recovery
Application Form: Artist’s Day
Complete and return the form by e-mail or post (e-mail is preferred) to:
E-mail applications to: bristolstudio@studioupstairs.org.uk
Postal address for applications: Artists Friday, Studio Upstairs, Units 1 & 2 Albion Dockside Estate,
Hanover Place, Bristol, BS1 6UT
Deadlines for return:
Term one (Soapstone Carving): Friday April 3rd 2015, 6pm
Term two (Introduction to Painting):Friday May 22nd 2015, 6pm
If places have been filled, we will add your name to our waiting list in case of drop-outs or future
programmes.
Term applied for: select with an X
Term one (Soapstone Carving):
11am - 4pm, Fridays: 17th April, 24th, then May 8th,
15th, 22nd and 29th 2015
Term two (Introduction to Painting):
11am - 4pm, Fridays 5th June to 10th July 2015
Personal Details
Title
Name
Surname
Address
Postcode
E-mail
Phone
Mobile
Name of next of
kin/emergency
contact number 1
Name of next of
kin/emergency
1
www.studioupstairs.org.uk
Units 1 & 2 Albion Dockside Estate
Hanover Place
Bristol
BS1 6UT
0117 930 0314
bristolstudio@studioupstairs.org.uk
Leading Creative Recovery
contact number 2
Are you in receipt
of any of the
following Benefits?
Mark with an X.
DLA
JSA
Housing Benefit
Other
Personal Statement
Please explain why you are applying for the Artist’s Day and why you would benefit from
it (200 words max). If someone is writing this on your behalf, they must complete the contact
information below.
What would you like to achieve as a result of attending? (Example: confidence/art-making
skills/meeting like-minded people/improved wellbeing) (100 words max).
Nominee Details
Complete this information if you are nominating the individual above or have written the statement of
support on their behalf.
2
www.studioupstairs.org.uk
Units 1 & 2 Albion Dockside Estate
Hanover Place
Bristol
BS1 6UT
0117 930 0314
bristolstudio@studioupstairs.org.uk
Leading Creative Recovery
Title
Position
Name
Surname
Address
Postcode
E-mail
Phone
Mobile
Equal Opportunities Monitoring Information
The following information does not form part of your application - it is used for statistical and monitoring
purposes in agreement with the Studio Upstairs Equal Opportunities and Diversity Policy.
This information should be for the applicant.
How did you come across this
opportunity?
Mark with X or if relevant specify detail
Search engine (please specify)
Studio Upstairs leaflet
Other Printed media (please specify)
Studio Upstairs website
Other website (please specify)
Jobcentre
Friend/relative/colleague
Employment agency (please specify)
Other (please specify)
3
www.studioupstairs.org.uk
Units 1 & 2 Albion Dockside Estate
Hanover Place
Bristol
BS1 6UT
0117 930 0314
bristolstudio@studioupstairs.org.uk
Gender (delete as
appropriate)
Leading Creative Recovery
Male/ Female/Transgender
Date of birth
ETHNICITY
Please indicate how you prefer to describe your ethnic origin.
Black British
Asian British
White British
Black African-Caribbean
Bangladeshi
White Irish
Black African
Indian
White Other
Black Other
Pakistani
Mixed
Chinese
Gypsy
Other
DISABILITY
_______________________________________________________________________
A disabled person is defined as a person with a physical, sensory or mental impairment which
has a substantial and long term adverse effect on his or her ability to carry out normal day-today activities.
Please state the nature of your disability
Do you have any medical conditions that we should be aware of? (Examples:
allergies/asthma/diabetes/epilepsy)
4