Application Form

Fill in the following items, and send the form to us to apply for entry.
Details of creator
Name

Pen name*If you choose to use one.

Creator’s nameAge
Disability type
Details of applicant (contact information) *Results will be mailed to this address.
Name

Applicant’s name
Relationship to artist[1] Artist himself/herself[3] Legal guardian[2] Person with parental responsibilities and rights (for a minor)[4] Juridical person entrusted with rights to the entered artwork

Address(If institution, etc.,
specify its name, inaddition to theaddress)

Phone/fax numbers

Phone

FaxE-mail* The applicant's personal information will be used to:[1] Notification regarding the public offering project (including the next fiscal year and onwards), sending of works and materials, and informationon other projects conducted by The Nippon Foundation DIVERSITY IN THE ARTS. [2] Publication of the name of the work and the name of theauthor at the exhibition, website, publicity objects issued by The Nippon Foundation DIVERSITY IN THE ARTS. [3] Provide applicants' personal
information to the extent necessary for the business consignee in order to carry out this project and other projects conducted by The Nippon
Foundation DIVERSITY IN THE ARTS. The Nippon Foundation DIVERSITY IN THE ARTS will conduct appropriate supervision, such asestablishing a manageable contract with the outsourcing company regarding handling.
* When The Nippon Foundation DIVERSITY IN THE ARTS acquires and uses the applicant's personal information for the purpose other than the purpose of use,
The Nippon Foundation DIVERSITY IN THE ARTS explains the contents such as the purpose of use, the method of use, the scope of use after getting the consentof the applicant individually.

Photo of the work for entry■ If you wish to enter more than one work,
Attach a photo of the work for entry here.

be sure to submit an application form for*Indicate the correct orientation of the work

each of the works.

(top and bottom) on the back of the photo.

■ Photocopy the completed application* If the work is a three-dimensional object, etc.,

form and keep it at hand.

attach a photo showing the front of the work.

■ The application form and the photoattached to it will not be returned.

Attach the photo the correct way up. If the work is taller than it is wide, attach thephoto so that the top is on the left.

Details of the work for entry
Year created
Title

Circle the item that applies to the work.
Painting or drawing (including Illustration, Computer graphics (printed out) .etc.) /Type

Calligraphic work/

Photo/

Three-dimensional art work/

Other (Specify):
Length/height

Width

Depth (If three-dimensional)

Size and weightcm

cm

Examples: acrylic and crayon on canvas, etc.

cm

WeightMaterialkg

About the creator（profile, history of creative activities, etc.）* Use a separate sheet if necessary. If using a separate sheet, do not staple the sheet to this form; simply enclose it with the form.

About the work for entry(Thoughts, feelings, etc., concerning/infused into the work; the background of its creation, etc.)* Use a separate sheet if necessary. If using a separate sheet, do not staple the sheet to this form; simply enclose it with the form.

■ Application:
Email: contest@diversity-in-the-arts.jp
The Nippon Foundation DIVERSITY IN THE ARTSInternational Communication Center for Persons with Disabilities (BiG-i)
Address: 1-8-1 Chayamadai, Minami-ku, Sakai City, Osaka 590-0115 JAPAN