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INTERNATIONAL IBSEN PROJECTS 2009
APPLICATION FORM FOR SCHOLARSHIPS

You are requested to send your application by e-mail to post@ibsenawards.com or by mail to:
Ibsen Awards, Skien kommune, kulturavdelingen, Postboks 4, 3701 Skien, Norway.
APPLICATIONS MUST BE SUBMITTED BY MAY 1st, 2009.
For further information, please contact:
Hilde Guri Bohlin · tlf: +47 35 58 10 00/917 67 903
   
         
    Information    
         
   
First name:
Middle name:
Surname:
Address:
Country:
Telephone number:
Mail Address:
Website:
   
         
    Institution responsible for the Project    
         
   
Name:
Address:
Country:
Mail Address:
Website:
Business register number:
   
         
    Project Description    
         
   
   
         
    Budget Estimate    
         
   
Expenses:
Fees / salaries to project participants:
(Please specify amounts due and
which category of fees and/or salaries
the figures relate to)
Production expenses - materials:
(Please specify, e.g. scenography,
costumes or printed material)
Rental expenses:
(Please specify, e.g. rehearsal studio,
performances, concerts or gallery)
Advertising and public communication:
Written material, photos,
audiovisual presentations:
Other relevant expenses:
(Please specify)
   
         
    Budget    
         
   
Income:
Verifiable financial support
granted from other sources:
Amount applied for
from Ibsen Awards 2009:
IBAN (International Bank Account No.):
Name and Address of Bank:
Swift / BIC Code:
   
         
    Material enclosed with this Application
(Please note that we are unable to return this material)		    
         
   
   
   
File upload:
   
         
    Curriculum Vitae of project participants at the date of Application
(Please give a brief description of the person's profession, educational background,
publications etc., his or her role in the project or any other information relevant to the application.
If need be, please add more names and columns than we have provided below.) 		   
         
   
Name:
Description
Name:
Description
Name:
Description
Name:
Description
Name:
Description
   
         
    Work Schedule for the Project    
         
   
Starting Date / Date of Completion:
Task:
Starting Date / Date of Completion:
Task:
Starting Date / Date of Completion:
Task:
Starting Date / Date of Completion:
Task:
Starting Date / Date of Completion:
Task:
   
         
   
Date: Signature: