BPR-0002(E)
Conseil des arts et des lettres du Québec
Jury and Peer Advisory Committee Application Form
This application form is intended for professional artists, writers and cultural managers.
Applicants should submit the completed form and their curriculum vitae (maximum of three pages) in Word or in PDF format at:
banque@calq.gouv.qc.ca
The information provided is confidential and is intended solely for the use of the Conseil.
Section 1 – Personal information
Surname : Given name :
Street address
No Street Apartment City or town Province Postal code
Postal address if different from the street address
No Street Apartment City or town Province Postal code
Home telephone number Other telephone number E-mail address
Section 2 - Demographic characteristics
Sex Date of birth Place of birth
Male Female YYYY-MM-DD Québec Other province of Canada Other country (specify) :
Ethnocultural group (check off only one box)
French English Aboriginal Other (Arab, Chinese, Latin American, and so on) (please specify):
Mother tongue: first language learned and still understood (check off only one box)
French English Other (please specify):
Languages
Spoken French English Read French English
Section 3 - Professional experience in the realm of the arts and literature
Indicate the number of the artistic field in which you primarily work:
01 - Architecture 02 - Circus arts 03 - Media arts (Film, video / New media)
04 - Multidisciplinary arts 05 - Visual arts 06 - Dance 07 - Literature 08 - Arts and crafts
09 - Music (Classical music, Non-classical music, Popular song) 10 - Theatre
When did your artistic career begin? :
Do you have relevant experience as a cultural manager? Yes No
If Yes, in what capacity?
Have you already participated in a jury or an advisory committee? Yes No
If Yes, for which organization(s)? Conseil des arts et des lettres du Québec Ministère de la Culture et des Communications du Québec
Canada Council Other public agency or private company
Section 4 - Attestation
I hereby declare that I am a Canadian citizen or a landed immigrant and that I have resided in Québec for at least 12 months.
I would like to be included in the Conseil’s bank of resource persons. If the Board of Directors accepts my application, I agree
that the personal information provided in this document may be used for research purposes to enable the Conseil to set up juries
or advisory committees or to select assessors.
I also understand that this information may be used to compile internal statistics on the bank of resource persons.
I acknowledge that submission by E-mail of this application form constitutes my signature.
I may at any time withdraw my name from the bank by notifying the Conseil to this effect.