2016-2017
Regional residency
Application deadline
YearMonthDay
20161031
.
Please consult theGrant Application Presentation Guide beforefilling out this form.
Please print in block letters if submitting a handwritten application. To facilitate photocopying, the application form and supporting documents must be printed on one side of the page only. Do not staple or bind the documents.
Identification of the applicant
Mr Ms / Name / First nameYear artistic practice started
Artistic discipline (indicate the appropriate discipline for your project and the specialty or field)
Landscape architectureCircus artsMultidisciplinary artsDigital artsVisual artsFilm and videoSong other than French-languageFrench-language song
StorytellingDanceEnvironmental designVideo installation
LiteratureArts and craftsClassical musicContemporary music
Non-classical musicArchitectural research Theatre Urban planning
Specialty, field or literary genre
Examples:Visual arts: specialty or field: paintingLiterature: literary genre: poetry
Amount requested / $
Nature and description of the project
Project titleProject duration / Start date (year/month) / Completion date (year/month)
Does your project rely on digital technologies (excluding office automation tools, such as word processing)? / Yes No
Attach a description of your project indicating, among other things, how it reflects your artistic or literary approach and how it will impact your work overall, your career and the intended community.
(Maximum of 4 pages in12-points type, or2000 words).
Submission of application
CALQ79, boul. René-Lévesque Est, 3e étage
3e étage
Québec (Québec) G1R 5N5 / Telephone:418 643-1707
Toll-free:1 800 608-3350
Website:
Required documents to attach to the duly completed and signed application form
Project description (max.: 4 pages)Curriculum vitæ (max.: 3 pages)
Detailed budget for the project / Work plan (max.: 2 pages)
Supporting documents to be examined with the application
(Attach five copies of the following supporting documents, identified with your name)
For theatre, the circus arts and multidisciplinary arts: a recent work presented on a DVD or CD or a compilation of selected works lasting no more than 15 minutes.For dance: a maximum of three choreography segments lasting no more than 15 minutes recorded on a DVD.
For music: a recent recording, in studio or in concert, of three works recorded on a DVD or CD.
For the digital arts, visual arts, arts and crafts, film and video art and architectural research: a maximum of 15 digital images or a compilation of selected works lasting no more than 15 minutes presented on DVD or CD.
For literature and storytelling: a recent work or a compilation of selected works lasting no more than 15 minutes presented on a DVD or CD. A book or manuscript excerpt.
Supporting documents must be presented on a DVD or CD, using one or more of the following software or plug-ins:
- Internet Explorer, version 10 or earlier.
- QuickTime version 7.7 or earlier - standard Macintosh video and audio format (.mov). Do not use an HD video format.
- Shockwave Player, up to version 11.6.
- Windows Media Player, up to version 12.
- Flash Player, up to version 13.
- Acrobat Reader, up to version 11.
- VLC Media Player.
For video, the recommended formats are MPEG 1 to 4, MOVand AVI. As for audio, the MP3 and M4A formats are suggested.
If the supporting items and documents cannot be presented in keeping with the above recommendations, please contact the program officer responsible at the CALQ.
The applicant is responsible for ensuring that all documents arrive intact and in the appropriate formats. The partners cannot be held responsible for any loss or damage resulting from the expedition or return of documents accompanying the application. We recommend that applicants avoid submitting the originals of works or documents to support the application.
Applications sent by fax or email will not be accepted. Only original copies of the application duly signed by the artist applicant will be considered valid. Incomplete applications and those submitted after the application deadline are not accepted.
Pursuant to the dispositions of the Act respecting Access to documents held by public bodies and the Protection of personal information, the CALQ and its partners agree to respect the confidentiality of the documents and information in their possession as well as those transmitted to them.
An applicant who changes address after submitting his application must notify the CALQ promptly to ensure that correspondence reaches him at his new address.
Description of audio and video supporting materials
Attach an additional page, if necessary.
Important: Make sure that your computer media are readable in the Windows environment. You are responsible for ensuring that all documents arrive intact at the CALQ and in the appropriate formats.In the case of video, MPEG (also called MPG) and AVI are the recommended formats; MP3 and CDA are the recommended audio formats.
Please read theGrant Application Presentation Guide for more information.
No. / Year created / Author, title of the work and a brief description of the document, if need be.
Special instructions, notes or warnings. / Length / Format / Applicant’s role in the production (performer, choreographer, designer, etc.) / Additional information
Description of handwritten, printed documents or visual material
Attach an additional page, if necessary (books, selected texts, scores, lyrics, scripts, digital images, etc.).
No. / Year created / Title of the work and exhibition centre or public place where it was photographed, if applicable / Medium / Dimensions
(in centimetres)
1Outaouais 2016-2017
The CALQ is not responsible for the loss or damage to materials sent with the file as a result of shipping. Applicants are urged to avoid sending the originals of items or supporting documents, except for copies of catalogues. Only visual material, sound recordings and publications are returned to applicants within 90 days of the announcement of the results.Identification of the applicant / This page is confidential and will be withdrawn during evaluation of the application.
Identification number
To avoid administrative errors concerning the identity of grant applicants, the CALQ requests the 6th, 8th and 9th digits of your social insurance number (SIN). Please fill in the appropriate boxes. / XXX-XX - X
Mr Ms / First and last names
(in block letters)
Street address
No.Street ApartmentCityProvincePostal code
Mailing address (if different from street address)
No.StreetApartmentCityProvincePostal code
*** ***-****
Telephone no.Email (required to send the acknowledgement of receipt)
(indicate the area code)
*** ***-****
Telephone no. (work)Website
(indicate the area code)
Applicant’s declaration and consent
In accordance with the general eligibility criteria governing the program, I hereby declare that: :
- I am a Canadian citizen or a landed immigrant as contemplated in section 2(1) of the Immigration and Refugee Protection Act.
- I normally reside in Québec and more specifically have resided in the region concerned for at least 12 months.
Should I obtain a grant to carry out this project, I, the undersigned, hereby consent to submission by the CALQ to the Société de télédiffusion du Québec (Télé-Québec) of the following nominative information: my name, civic address, telephone number, email address, the title and a description of my project and the anticipated date of its completion. This information will be submitted to Télé-Québec in order to foster better promotion on television or the Internet of the artistic and literary activities that the CALQ supports in all regions of Québec. Accordingly, I also agree that a representative of Télé-Québec may contact me directly in order to promote my project insofar as a television broadcaster selects the project. Yes No
I authorize the CALQ to conduct the necessary verifications with other granting agencies to ensure that the funds granted in respect of this application do not cover any expense pertaining to a project already supported under a program of any other agency.
I have applied for another grant in respect of the same project Yes
No / If so, from which organization?
Name of program / Application date
I agree to abide by the rules of the program stipulated in the brochure and to comply with the decision of the CALQ, which is final and cannot be appealed.
I also undertake to submit a detailed Report on the use of a grant within three months after completion of the project.
I hereby certify, in good faith, that the information provided is accurate and complete.
Signature / Date
Applications sent by fax or email will not be accepted. Only the original copy of the application form duly signed by the artist will be considered valid.
General information for statistical purposes only
This questionnaire is intended to provide statistics on the socio-economic status of professional artists who apply for grants offered by the CALQ. This information will be taken into account when the program is adjusted and will make it possible to assess and enhance the CALQ’s initiatives to assist artists.The information you provide is confidential and will be used for statistical purposes. This page will be withdrawn during the evaluation process.
Artists who have registered may consult the nominative information pertaining to them in the CALQ’s possession, pursuant to sections 83 to 85 of the Act respecting Access to documents held by public bodies and the Protection of personal information, especially with respect to the collection of personal information.
Thank you for your collaboration.
Demographic characteristics
Mr Ms / First and last names(in block letters)
Gender Female
Male / Date of birth / Year / Month / Day / Mother tongue French English
Other (specify)
Place of birth Québec Otherprovince Other country (specify)
To which ethnocultural group do you belong?
French English Aboriginal Other (Arab, Chinese, Latin American, etc.) Specify:
Professional characteristics
Main occupation (check only one item)Professional artist, writer or craftsperson Teacher Other
What artistic training do you have? / Place of training
Québec / Other province / Other country
University degree
Cegep diploma or equivalent
Diploma from a public institution (conservatory, national school, autre)
Diploma or certificate from a private arts school
Training with one or more recognized artists
Other art training (specify)
Self-taught
Have you participated in skills upgrading sessions in the past three years? Yes No
Québec Other province France United States
Other country (specify)
Have you received any grants during the past three years? Yes No
CALQ Other public organization or private company
Canada Council for the Arts
Please indicate your income category over the past year:
Less than $20,000 $20,000 to $29,999 $30,000 to $39,999 $40,000 or more
What proportion of your overall income results from your artistic activities?
Less than 25% 25% to 49% 50% to 74% 75% or more
During the past three years, has your work been disseminated outside Québec or have you participated in the promotion of works from Québec outside of Québec? Yes No
Other province France United States Other country
1Outaouais 2016-2017