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Foreign languages that you can use, indicating your proficiency in reading, speaking, and writing each: Spanish Professional organizations of which you are a member: Positions that you have held (professional, teaching, administrative, and business), beginning with your current position and working backwards: Name of Institution or Organization CAL ARTS ARTIST IN RESIDENCE PROGRAM Position (Full Title) ARTIST IN RESIDENCE Dates of Tenure 1996 Name of Institution or Organization UNIVERSITY OF IOWA Position (Full Title) ARTIST IN RESIDENCE Dates of Tenure 1991 Name of Institution or Organization ARTIST TELEVISION NETWORK Position (Full Title) PRESIDENT Dates of Tenure 1977-1985 REFERENCES: List the names and postal mailing address of four persons who are familiar with your work and to whom the Foundation may write for expert judgment concerning your abilities, especially in relation to your proposal for the use of a Fellowship. (All statements by references to the Foundation are held in the strictest confidence.) Name SUSAN HOELTZEL Postal address 250 BEDFORD PARK BLVD WEST BRONX, N.Y. 10468 Zip Code Position ART GALLERY Name PEDRO CUPERMAN Postal address 216 HB CROUSE SYRACUSE UNIVERSITY SYRACUSE NY 13244 Zip Code Position DIRECTOR SYRACUSE VIDEO FESTIVAL Name BARBARA ABRASH ASS. DIRECTOR CENTER MEDIA ARTS Postal address 25 WAVERLY PLACE NEW YORK N.Y. 10003 Zip Code Position ASS. DIRECTOR MEDIA ARTS Name BERTA SICHEL DIRECTOR VIDEO, MUSEO MACIONAL REINA SOFIA Postal address SANTA ISABEL 52 28012 MADRIO SPAIN. Zip Code Position DIRECTOR VIDEO PROGRAMS You are advised that, in accordance with the provisions of the Federal Tax Reform Act of 1969, all successful applicants for Fellowships will be required to submit, at the conclusion of their Fellowship terms, reports summarizing what they have accomplished and accounting for the funds they have received. Your signature below indicates your acceptance of the rules and conditions of the competition as stated in the four pages of this form. NAME JAMIE DAVIDOVICH SIGNATURE /S/ JAMIE DAVIDOVICH PLACE AND DATE OF MAILING NEW YORK SEPTEMBER 19, 2005 If you do not receive an acknowledgment of your application within a reasonable time, please notify the Foundation. If you move after filing this application, please notify the Foundation of your new address.