Art Residency Discharge Form
Complete this form to finalize your departure from the art residency program.
Resident Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Residency Program Name
*
Residency Period (Start and End Dates)
*
Studio/Unit Number
*
Please confirm all keys, materials, and equipment issued to you have been returned.
*
All items returned
Some items missing (please specify below)
If any items are missing or damaged, please specify:
Please rate your overall experience at the residency.
*
1
2
3
4
5
Additional Comments or Feedback
I confirm that the studio/unit has been cleaned and is in the same condition as upon arrival.
*
Studio/unit cleaned and restored
Resident Signature
*
Submit Discharge Form
Submit Discharge Form
Should be Empty: