Pocoapoco Family Residency

We look forward to having you here in January! Please fill out this brief questionnaire so we can learn a little more about you and take your interests into consideration as we plan our week together.

This questionnaire is based on our residency application, but please don’t feel obliged to answer all the questions unless they feel applicable and or fun.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Country

(###)

###

####

Date of birth

YYYY

Website (if applicable)

http://

Pronouns

Who are you? A brief bio:

Please explain the work or research you would like to explore over the course of your stay

How would you describe the personal connection you have with your work or creative practice? (not required)

How, if applicable, does your work or practice connect to, impact or communicate with others? With what communities do you work within or alongside? (not required)

Do you have any allergies, dietary restrictions or medical conditions we should take into consideration? Any restrictions on physical activity?

Additional thoughts, ideas, feelings etc