*Name:

*Email:

*Phone:

*Columbia affiliation: Select status Undergrad Student Grad Student Faculty Staff Alumni Other

*Address:

*City:

*State:

*Zip:

*Supply your Artist Statement in the space below (examples):

*Total Number of Works Submitted:

Please include information for each work you are submitting:

If you wish to submit more than five works, please contact Larry Oberc at loberc@colum.edu or 312.369.7157.