Formulaire Artistes fonds - Conseil des arts et des lettres du Québec

Ordre des arts et des lettres du Québec
Honorary distinction medal created
by Christine Dwane.
Photo: Anthony McLean
Identification of candidate
Year artistic practice or involvement in the arts and literature began:
Mr
Ms
Name
Given name
Street address
No.
Street
Apartment
City
Province
Postal code
Apartment
City
Province
Postal code
Mailing address if different from the street address
No.
Street
(***) ***-****
**********@***.****
Telephone (indicate the area code)
Email
(***) ***-****
www.**********.***
Telephone (work)
Website
Artistic discipline (indicate one or more disciplines)
Visual arts
Circus arts
Digital arts
Multidisciplinary arts
Popular song
Film – video
Dance
Literature and storytelling
Arts and crafts
Music (classical, non classical or contemporary)
Multidisciplinary
Architectural research
Other (specify)
Theatre
The file must contain one copy of the following documents:
Short text of supporting argument (2 pages or 500 words)
The candidate’s curriculum vitæ along with a short biography;
Two letters of support from persons or organizations recognized in the arts and literature domains in Québec.
Files in support of a candidacy must be expedited by mail or messenger no later than April 1, 2016. The postmark or delivery
slip date is deemed to be the date of receipt of the application. Files should be sent to the following address:
Ordre des arts et des lettres du Québec
Conseil des arts et des lettres du Québec
79, boulevard René-Lévesque est, 3e étage
Québec (Québec) G1R 5N5
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Information on the author of the candidate’s nomination
Mr
Ms
Mailing address
No.
Name and Given name
(in block letters)
Street
Apartment
(***) ***-****
Telephone (indicate the area code)
City
Province
Postal code
**********@***.****
Email
Declaration by the author of the candidate’s nomination
As the author of the candidate’s nomination for the Ordre des arts et des lettres du Québec,
• I have carefully read the general conditions for eligibility and I affirm that the candidate complies.
• I agree to respect the decision of the Conseil des arts et des lettres du Québec.
• I agree to respect the confidentiality of the results until the date of the public announcement.
Name of the organization, if applicable
Signature of the author of the candidate’s nomination
Role
Dated:
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