Arts for Social Change Application Form
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This is the application just for the South Africa programme, which should be returned to Nicole Antonie on nicole@pioneersofchange.net by December 15th at the latest, but please fill it out as soon as you know you would be available and interested to join the programme. Participants selected will be notified by the 30th December 2004, to provide time for fund-raising should this be necessary.
If you have any questions about the programme and whether it is right for you, if you would like to sign up to the arts@lists.pioneersofchange.net email list, if you would like the full programme description, or if you would like to know about how to support in other ways, please email nicole@pioneersofchange.net.
Name:
Organization / Affiliation:
Nationality:
Passport Number:
Age:
Email address:
Mailing Address:
Phone number:
Fax:
- Please write a short biography about yourself, sharing with us, the work you are involved, your passions and interests, so that we can introduce to other young innovators from around the world
- What is your intention for joining the learning journey? How do you think your participation will add to the learning? How do you hope it will contribute to your own work?
- What does it mean to you to be an artist?
- What would you, at a personal level, like to learn on this programme and bring to this programme? Is there any specific process or project you would like to introduce the other participants to in a session? Please note that this does not have to be art-based.
- Do you have any ideas/ inputs for the design of the programme? Anything specific you would like to see?
- Do you need a visa to enter South Africa?
- COSTS: The participation fee is $700, which does not cover international transportation costs. Please let us know if this cost will be a problem for you, there MAY be a few scholarships covering participation available. We are currently working on fundraising and on identifying other creative ways of getting people there! If you would like to support our efforts by helping us fundraise through some of your contacts or by contributing to someone else's travel, please let us know as soon as you can!
- Anything you would like to add? Do you mind if we share your answers to the questions above with the other participants?
Nicole Antonie
+ 27 82 858 8095
nicole@pioneersofchange.net
www.pioneersofchange.net
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