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INTERNATIONAL IBSEN SCHOLARSHIPS 2010
APPLICATION FORM FOR INTERNATIONAL IBSEN PROJECTS

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 APRIL 15th, 2010.
For the application to be processed, all parts of the application form must be filled out.
The application must be in English or Norwegian.
For further information, please contact:
Hilde Guri Bohlin · tlf: +47 35 58 10 00/917 67 903
   
         
    Applicant    
         
   
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*    
         
   
The project description must seek to explain how the project contributes to a critical discourse in regards to existential and/or society-related subject matters concerning Henrik Ibsen. (cf statute 2).
 
The project description must contain a detailed description of the project.
   
         
   
   
         
    Budget Estimate    
         
   
A detailed budget must accompany the application and the amount applied for from Ibsen Award specified.
   
         
   
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)
   
         
   
Total expenses*:
   
         
   
Income*:
Verifiable financial support
granted from other sources:
Amount applied for
from Ibsen Awards*:
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: