2017 Institute Fellow Application
(1) Personal Information
Full Name:
Mailing Address
Street:
City: State: Zip Code:
E-mail address: Phone Number:
(2) Professional Information
Most Advanced Degree (please identify):
__ PhD __ MFA __ MA __ BA/BS Other: ______
Institution: ______
Degree date:
__ Year: 2000 or later __ 1900-2000 __ 1980-1990 __ Before 1980
(3) Social Media Profile
Facebook: ______
Linkedin: ______
Twitter: ______
Vimeo: ______
Soundcloud: ______
Youtube: ______
Instagram: ______
Pinterest: ______
Other: ______
(4) Primary Documentary Media: (Select all that apply)
__ Audio
__ Video
__ Photography
__ Written Word
__ Multimedia
__ Exhibition
__ Archive
__ Other (Please specify:) ______
(5) Work Examples
Links to Samples of Your Work:
Please provide links to 2-3 examples of your documentary work or project (s) available for consultation on the Web.
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(6) Project Description
In 300-500 words, please briefly describe the project you would bring and its goals and what you hope to accomplish towards those goals in the Institute.
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(7) Statement of Purpose
In up to 750 words, please describe how summer program fits into your academic, professional and future plans. Please be specific. For example:
· Discuss your training, ethos, driving interests, and how they connect with the mission of MDOCS and documentary as part of the liberal arts
· Indicate any special skills, interdisciplinary approaches or international experience that you bring to the program.
· State your experience creating one or more of the following; film/video, photography, audio, exhibitions, archival projects, documentary non-fiction, or new media.
· State your experience in teaching or mentoring documentary work
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By submitting this application, you certify that information contained herein is true and complete. I understand that false information may be grounds for not selecting me or for revocation of my invitation. I authorize the verification of any or all information listed above.
Please sign and date above