INDEPENDENTLY-FUNDED RESIDENCY APPLICATION FORM

Please submit your application for an Independently-Funded Residency at Artica Svalbard using the below form.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Country

(###)

###

####

Nationality

Profession / Discipline:

Current Affiliation (if any):

Website

http://

Preferred residency option

Title of project / research:

Description of project / research:

500 words max

Why is it necessary that your residency is in Svalbard?

300 words max

Would you be interested in hosting a public engagement event, what format might this take, and how do you foresee this benefiting the community / your work, or both?

300 words max

Preferred date of arrival

YYYY

Preferred date of departure

(Minimum of three weeks after arrival date)

YYYY

Any specific needs or requirements for your stay

(e.g., equipment, accessibility needs)

Do you already have funding to cover the costs of your residency secured?

Source of funding: