Application Form | Artist-in-Residence｜富山ガラス造形研究所

【1】Name（full name） ※

Example: First name Middle name Family name
※Half-width alphanumeric

(50 characters or less)

【2】Name　(Chinese Character)

If your name can be written in Chinese characters, please write.
(Full-width 20 characters or less)

【3】Home address ※

Please write your address including postal code and country.
※Half-width alphanumeric

(2000 characters or less)

【4】Phone number ※

(30 characters or less)

【5】e-mail address ※

※mobile phone e-mail address not allowed

Please enter your email address again for confirmation.

【6】Date of birth ※

Entry example：mm/dd/yyyy
：05/10/1995
（Half-width）

(10 characters or less)

【7】Gender ※

Woman Man Non-binary Prefer not to answer

【8】Occupation ※

※Half-width alphanumeric
(400 characters or less)

【9】Work / School address ※

※Half-width alphanumeric
(400 characters or less)

【10】Work / School phone number

(Hyphen separated) Example:012-345-6789

【11】Emergency contact ※

※Half-width alphanumeric
(200 characters or less)

【12】Emergency contact Phone number ※

(Hyphen separated) Example:012-345-6789

【13】Emergency contact e-mail address ※

Please enter your email address again for confirmation.

【14】Statement of Intent（1200 characters maximum）※

※Please provide a statement of intent outlining the primary concepts, goals and plan of your proposed residency.
※Please include in your statement how you plan to engage with the local community and how being in Toyama will play a role in the development of your work.
※Half-width alphanumeric

(1200 characters or less)

【15】Production plan (1200 characters maximum) ※

※Applicants must outline any potential health hazards (e.g. fumes, dust, or any other hazardous materials) associated with the techniques to be used during the residency.
※Half-width alphanumeric

【16】Hot shop usage (days) ※

【17】Hot shop assistant (1 person) ※

Need Do not need

【18】Kiln usage (days) ※

【19】Cold shop usage (days) ※

【20】Resume　（1800 characters maximum) ※

※Half-width alphanumeric
(1800 characters or less)

◆Image attachments
Please attach up to 1 Self-portrait (taken within the last 6 months) and up to 10 images of your work.
The size of the photo should be up to 1200 pixels in height and width.
The attached file should be JPEG format (extension is jpeg or jpg), and up to 2MB per file.
The file title should be "Name (example:John Smith.jpg)" for the self-portrait and "image number_ work title_surname (example:01_the wall_Smith.jpg)" for the work image.

【21】Self-portrait ※

face photo taken within the last 6 months
file label : name.jpg
e.g. John Smith.jpg

Image 01

【22】Image 01

file label : image number_title_surname
e.g. 01_the wall_Smith.jpg

【23】Image 01 information

title/dimension/technique/production year
e.g. the wall/H650×W680mm/cold work/2020

(200 characters or less)

【24】The work of image 01 was designed by applicant.

Yes No

【25】The work of image 01 was produced by applicant.

Yes No

Image 02

【26】Image 02

file label : image number_title_surname
e.g. 02_the wall_Smith.jpg

【27】Image 02 information

title/dimension/technique/production year
e.g. the wall/H650×W680mm/cold work/2020

(200 characters or less)

【28】The work of image 02 was designed by applicant.

Yes No

【29】The work of image 02 was produced by applicant.

Yes No

Image 03

【30】Image 03

file label : image number_title_surname
e.g. 03_the wall_Smith.jpg

【31】Image 03 information

title/dimension/technique/production year
e.g. the wall/H650×W680mm/cold work/2020

(200 characters or less)

【32】The work of image 03 was designed by applicant.

Yes No

【33】The work of image 03 was produced by applicant.

Yes No

Image 04

【34】Image 04

file label : image number_title_surname
e.g. 04_the wall_Smith.jpg

【35】Image 04 information

title/dimension/technique/production year
e.g. the wall/H650×W680mm/cold work/2020

(200 characters or less)

【36】The work of image 04 was designed by applicant.

Yes No

【37】The work of image 04 was produced by applicant.

Yes No

Image 05

【38】Image 05

file label : image number_title_surname
e.g. 05_the wall_Smith.jpg

【39】Image 05 information

title/dimension/technique/production year
e.g. the wall/H650×W680mm/cold work/2020

(200 characters or less)

【40】The work of image 05 was designed by applicant.

Yes No

【41】The work of image 05 was produced by applicant.

Yes No

Image 06

【42】Image 06

file label : image number_title_surname
e.g. 06_the wall_Smith.jpg

【43】Image 06 information

title/dimension/technique/production year
e.g. the wall/H650×W680mm/cold work/2020

(200 characters or less)

【44】The work of image 06 was designed by applicant.

Yes No

【45】The work of image 06 was produced by applicant.

Yes No

Image 07

【46】Image 07

file label : image number_title_surname
e.g. 07_the wall_Smith.jpg

【47】Image 07 information

title/dimension/technique/production year
e.g. the wall/H650×W680mm/cold work/2020

(200 characters or less)

【48】The work of image 07 was designed by applicant.

Yes No

【49】The work of image 07 was produced by applicant.

Yes No

Image 08

【50】Image 08

file label : image number_title_surname
e.g. 08_the wall_Smith.jpg

【51】Image 08 information

title/dimension/technique/production year
e.g. the wall/H650×W680mm/cold work/2020

(200 characters or less)

【52】The work of image 08 was designed by applicant.

Yes No

【53】The work of image 08 was produced by applicant.

Yes No

Image 09

【54】Image 09

file label : image number_title_surname
e.g. 09_the wall_Smith.jpg

【55】Image 09 information

title/dimension/technique/production year
e.g. the wall/H650×W680mm/cold work/2020

(200 characters or less)

【56】The work of image 09 was designed by applicant.

Yes No

【57】The work of image 09 was produced by applicant.

Yes No

Image 10

【58】Image 10

file label : image number_title_surname
e.g. 10_the wall_Smith.jpg

【59】Image 10 information

title/dimension/technique/production year
e.g. the wall/H650×W680mm/cold work/2020

(200 characters or less)

【60】The work of image 10 was designed by applicant.

Yes No

【61】The work of image 10 was produced by applicant.

Yes No

【62】Thumbnail image document ※

Thumbnail document should include the work number, thumbnail image, title, size, technique, and year of production in PDF format.

※The file label should be "your name_thumbnail.pdf"
(Example: John Smith_thumbnail.pdf)

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Artist-in-ResidenceApplication Form

Artist-in-Residence
Application Form