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Application Form 1: Mindscreen Film Institute

The document is an application form for the Mindscreen Film Institute's filmmaking courses. It lists the required documents for application, which include registration fees, a completed application form, statement of purpose, educational certificates, experience certificates if applicable, age and address proofs. The form requests personal details of the applicant like name, date of birth, contact information, education qualifications, work experience if any, languages known, references and a declaration signed by the applicant. It seeks information on the course applying for and how the applicant intends to join the film industry post course.

Uploaded by

Gowtham Naidu B
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© Attribution Non-Commercial (BY-NC)
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Download as PDF, TXT or read online on Scribd
87 views6 pages

Application Form 1: Mindscreen Film Institute

The document is an application form for the Mindscreen Film Institute's filmmaking courses. It lists the required documents for application, which include registration fees, a completed application form, statement of purpose, educational certificates, experience certificates if applicable, age and address proofs. The form requests personal details of the applicant like name, date of birth, contact information, education qualifications, work experience if any, languages known, references and a declaration signed by the applicant. It seeks information on the course applying for and how the applicant intends to join the film industry post course.

Uploaded by

Gowtham Naidu B
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MINDSCREEN FILM INSTITUTE

# 4, Kanniamman Koil Street, Dr.Ranga Road, Mylapore, Chennai 600 004, Phone: +91 044 4210 8682 / 2499 6417, Fax: +91 044 2431 0655 E-mail: [email protected] , Web: www.mindscreen.co.in

APPLICATION FORM
CHECKLIST FOR APPLICATION APPLICATIONS MUST BE COMPLETED AND THE FOLLOWING DOCUMENTS SHOULD BE SUPPORTED o o o o o o o Registration fee* Legibly filled in Application ( fully completed) Statement of Purpose. Xerox copies of School/ Graduation Certificates Experience certificate (For Experienced Candidates) Age proof Certificate Proof of Residence

1
APPLICATION NUMBER

YOUR LATEST PHOTOGRAPH

REGISTRATION FEES (Payment by Draft for outstation students) *The registration fee of R 2250.00 (inclusive of 12.36% service tax) is non-refundable and payment to be made favoring MINDSCREEN FILM INSTITUTE payable at Chennai along with this duly filled in application form. FOR OFFICE USE ONLY Received payment of Rs. on vide DD/ Local Cheque/Cash No ..dateddrawn. Receipt No : dated All information provided by you should be true and in the event of any falsified information, the Institute has the right to withhold or cancel your Application and no refund of the Registration fee will be made.

HOW DID YOU COME TO KNOW ABOUT MINDSCREEN FILM INSTITUTE? (PLESSE TICK) 1) 2) SEARCH ENGINE: GOOGLE, YAHOO, REDDIFF, SIFY, FACE BOOK, LINKEDIN, TWITTER, MSN.OTHERS WEB SITE 3) ALUMNI 4) PRESS 5) MEDIA 6) OTHERS

WHICH COURSE DO YOU WISH TO APPLY? (PLESAE TICK THE APPRORAITE)


SIX MONTHS COURSE ON CINEMATOGRAPHY SIX MONTHS COURSE ON SCREEN WRITING & FILM MAKING THREE MONTHS ACTING FOUNDATION COURSE. ACTING WORKSHOP PHOTOGRAPHY WORKSHOP

MINDSCREEN FILM INSTITUTE


NAME OF THE STUDENT DATE OF BIRTH

DATE

MONTH

YEAR

SEX

STUDENTS E-MAIL ID STUDENTS MOBILE NUMBER STUDENTS PASSPORT NO BLOOD GROUP NATIONALITY STUDENTS VOTERS ID NUMBER NATIVE STUDENTS DRIVING LICENCE NUMBER MOTHER TONGUE MARTIAL STATUS MARRIED SINGLE

NAME OF THE PARENT/GAURDIAN PARENTS E-MAIL ID PARENT/GAURDIANS MOBILE NUMBER PERMANENT ADDRESS LANDLINE NUMBER WITH STD CODE

ADDREESS OF CORRESPONDENCE /COMMUNICATION

PARENTS OCCUPATION PARENTS ANNUAL INCOME

Rs

MINDSCREEN FILM INSTITUTE

MARK DETAILS OF 10 + 2 MONTH/YEAR

SUBJECT

MAXIMUM MARKS

MARKS OBTAINED

% OF MARKS

SCHOOL

TOTAL MARKS DETAILS OF COLLEGE /UNIVERSITY MONTH/YEAR SUBJECT MAXIMUM MARKS

MARKS OBTAINED

% OF MARKS

COLLEGE / UNIVERSITY

TOTAL MARKS DETAILS OF PG /DIPLOMA COURSE MONTH/YEAR SUBJECT MAXIMUM MARKS

MARKS OBTAINED

% OF MARKS

COLLEGE / UNIVERSITY

TOTAL TECHINICAL COURSE / WORKSHOP/SEMINAR ATTENDED

MINDSCREEN FILM INSTITUTE

STATEMENT OF PURPOSE TO WHY YOU WISH TO TAKE UP A CAREER AS A CINEMATOGRAPHER / SCREEN WRITER/DIRECTOR OR ACTOR (TO BE WRITTEN ACCORDING TO THE COURSE APPLIED FOR WITHIN 200 WORDS STRICTLY)

ON COMPLETION OF THE COURSE, HOW DO YOU INTEND TO JOIN THE FILM INDUSTRY?

MINDSCREEN FILM INSTITUTE


WORK EXPERIENCE, IF ANY COMPANY / PRODUCTION PERIOD
DESIGINATION

5
JOB SPECIFICATIONS/WORK

SHORT FILMS WRITTEN /DIRECTED OR SHOT BY YOU? IF YES, TITLE OF THE SHORT FILM AND LINK OF THE SAME OR A BRIEF ABOUT

DO YOU HAVE A FACEBOOK/TWITTER OR LINKEDIN ACCOUNT, IF YES FURNISH DETAILS

KNOWLEDGE IN COMPUTER OPERATIONS (TICK WHICHEVER IS APPLICABLE) MS OFFICE ADOBE PHOTOSHOP ADOBE PREMIERE EXCELLENT EXCELLENT EXCELLENT GOOD GOOD GOOD AVERAGE AVERAGE AVERAGE

NIL NIL NIL

LANGUAGE PROFICIENCY (TICK WHICHEVER IS APPLICABLE)

ENGLISH READ HINDI TAMIL


MALAYALAM TELUGU KANNADA OTHERS ( )

READ
READ

SPEAK SPEAK
SPEAK

WRITE WRITE WRITE WRITE WRITE WRITE WRITE

READ READ READ READ READ

SPEAK SPEAK SPEAK SPEAK

WHAT ARE YOUR HOBBIES? ______________________________________________________________________________________ _________________________________________________________________________________________________________________________ IS THERE ANY HEALTH ISSUE THAT YOU WISH TO KEEP US INFORMED? YES NO

WE STRONGLY ADVICE STUDENTS TO ACQUIRE HEALTH INSURANCE, PLEASE CONTACT US FOR MORE INFORMATION

6
MINDSCREEN FILM INSTITUTE
REFERENCES:

LIST NAME OF TWO PERSONS WHO WILL SERVE AS REFERENCES; 1. NAME: ____________________________________DESIGNATION_________________________MOBILE___________ ADDRESS:__________________________________________________________________________________________________ _______________________________________________________________________________________________________________ E-MAIL_____________________________________________________________________________________________________ 2. NAME: ____________________________________DESIGNATION_________________________MOBILE___________ ADDRESS:__________________________________________________________________________________________________ _______________________________________________________________________________________________________________ E-MAIL______________________________________________________________________________________________________

APPLICANT SIGNATURE Declaration: I hereby certify that the information I have provided on this application form is complete and accurate to the best of knowledge and I am liable for disqualification or dismissal at any time if the stated information is found to be incorrect or misleading.

SIGNATURE OF THE APPLICANT: __________________________________ DATE: ______________ PLACE: __________________

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