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John Simon Guggenheim Memorial Foundation

90 Park Avenue New York, N.Y. 10016 http://www.gf.org

Applications and accompanying documents from citizens and permanent residents of the United States and Canada should reach the office of the Foundation not later than October 1; from citizens and permanent residents of Latin America and Caribbean, not later than December 1.

PLEASE TYPE OR PRINT.
SEND THIS FORM AND ACOMMPANYING MATERIAL BY POSTAL MAIL. DO NOT SEND IT BY FAX OR EMAIL. 

Last name First Middle
Preferred mailing address 
Zip Code
Telephone

Home address (if other than above)
Zip Code
Telephone

FAX number and Email address 

Title of present position (include name of institution, if any)

The specific field of scholarship or art in which your 
proposal lies

The title of your project   STOP AND REWIND

The inclusive dates of the period for which you are requesting a Fellowship

Place of birth    Buenos Aires/Argentina

Date of birth 9/29

Sex M

Citizenship USA

If not a native-born citizen, give date and place of naturalization: 

 and address of spouse or nearest kin  NINA

[[4 Columned Table]]

| Educational Summary | Name of Institution | Period of Study (inclusive dates) | Degrees, Diplomas, Certificates (with dates) |

| --- | --- | --- | --- |

| Academic: Undergraduate |  |  |  | 
| Academic: Graduate |  |  |  | 
| Academic: Other: (Artistic, Musical, etc., where pertinent) |  |  |  | 

Transcription Notes:
Spacing? Comprehension of material? Lower case?