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Foreign languages that you can use, indicating your proficiency in reading, speaking, and writing each:

Professional organization of which you are a member:

Positions that you have held (professional, teaching, administrative, and business), beginning with your current position and working backwards: 

[[3 Columned Table]]

| Name of Institution or Organization | Position (Full Title) | Dates of Tenure |
|---|---|---|
| ATW president |   | 1976 - 1984 |
| CAL ARTS Venice | Artist in Residence | 1992 |
| University of Iowa, Iowa City | Artist in Residence | 1978 |

References: List the names and postal mailing addresses of four persons who are familiar with your work and to whom the Foundation may write for expert judgement 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 
Postal Address 
Zip Code
Position  Susan Hoetzel 

Name
Postal Address
Zip Code
Position Barbara Amash

Name 
Postal Address 
Zip Code
Position Julia Hughes

Name
Postal Address
Zip Code
Position Pedro Cuplema [[arrow to Julia Hughes' name]]
Pedro Colo

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 (typed or printed) SIGNATURE 
PLACE AND DATE OF MAILING 

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.