APPLICATION FORM 'WORKING TITLE 4' Complete and submit the following application form. Please print clearly and attach a separate page if needed. These details will not be disclosed to anyone outside of Channel 31 without the applicants permission
Name
Date of Birth
- - / - - / - - - - Male ☐
Cultural and/or religious background
Languages spoken other than English
Address (with Postcode)
Home phone number
Mobile phone number
Any dietary and/or religious requirements?
Are you an Australian Citizen or Permanent Resident?
Are you a member of any youth or Arts Organisation such as C31, SYN etc? Which ones?
Where did you hear about Working Title?
EMERGENCY DETAILS
Name of Emergency contact person
Relationship to Applicant
Emergency contact phone number
Do you have any allergies or are you taking any medication?
Medicare number
Female ☐
INTERESTS AND EXPERIENCE 1 ‐ In a few sentences, please tell us a bit about yourself, what you do, what you like, and what you're passionate about
2 ‐ Why are you interested in taking part in Working Title?
3 ‐ What are some issues that concern you as a young person in a Multicultural society?
4 ‐ If you were selected to be part of the project tell us about one idea that you would present for a 5‐10min Documentary Film
5 ‐ Tell us a bit about your experience (if any) in filmmaking or storytelling? And What specific area/s of Filmmaking interests you the most: Writing, Pre‐Production, Camera, Sound, Lighting, Editing or Directing?
6 ‐ Do you think you can commit yourself to being involved from September until December? (Workshops every Saturday for 8 weeks starting Sept. 27, 10am – 4pm, plus a week of filming in November and editing in December)
PHOTOGRAPHY CONSENT FORM Do you give C31 permission to take photos or video footage of you during the project? The Photos and footage will be used to promote the project and may also be included in the final DVD packaging and studio interview shoot. The photos and video may also be used to promote similar projects to young people with organisations involved in Working Title If you would prefer not to be photographed or filmed that is okay, just let us know on this form so we do not include you in the photographs or video footage. I DO/DO NOT (please underline) wish to be photographed by C31 I DO/DO NOT (please underline) wish to be filmed by C31 APPLICATION CONSENT (if over 18years of age) Applicant signature (sign) Applicant Name (print clearly) PLEASE POST OR EMAIL THIS APPLICATION FORM TO ADDRESS Working Title C/‐ Channel 31 Level 11, 277 William Street, Melbourne, VIC 3000 OR EMAIL workingtitle@c31.org.au IF YOU HAVE ANY QUESTIONS OR WOULD LIKE MORE INFORMATION, PLEASE CONTACT Kelly West, Project Manager on 0433766705 www.c31.org.au/workingtitle