APPLICATION FORM SL. ICE/AF/BOM/_______
DATE:______________
Hello and Welcome to ICE. Provide all information requested in this form which will help us guide you to the program that best suits you. Make all entries in BLOCK Letters.
Name First Name Date of Birth D
Middle Name Languages Known
Gender
D M M Y Y Y Y
M
Last Name
F
Address for correspondence (in BLOCK Letters)
City
Pincode
Residence Number Marital Status :
State
Mobile Number Single
Email Id
Married
Education Qualification [Highest Education] Qualification
University / Board
Year of Passing
Specialization Subjects
Percentage
Training in Media and Entertainment Name of Course
Institute / Academy
Year of Passing
Total Work Experience (Descending Order) Period Worked From
Name of Organisation
Position
Specialization
Monthly Family Income Below Rs.15,000/-
To
Rs.15,000/- to 25,000/Rs.25,000/- to 40,000/Rs.40,000/- & above Work Experience in Media and Entertainment Period Worked From
Name of Organisation
Position
To
Have you attended any Auditions. If yes, kindly mention details below Month of Audition
Name of the Production House / Project
Selection Status [Selected / Not Selected]
I came to know about ICE through (Tick Appropriate) Emailer
Hoonur
Relative / Friend
TV
Internet
Attended a Seminar / Presentation at School / College
Hoarding / Kiosk / Poster / Banner
At an Audition
Received a call from ICE
Newspaper AD
Paper Insert
Radio Ad
Course Interested in (Tick Appropriate) Acting
Direction
Script Writing
Editing
Cinematography
Production
Sound Recording
Duration
Fees
Others While counseling I would like ICE Counselor to emphasize on Course Content
Live Environment
Faculty Credentials
DECLARATION TO BE SIGNED BY THE APPLICANT I do hereby declare that all the statements made in the above form are true, complete and correct to the best of my knowledge and belief. Place: _______________________
________________________ (Signature of the Applicant)
------------------------------------------------- For Office Use ------------------------------------------------A. Interview
Conducted By : ________________
Status
Shortlisted
Not Shortlisted
B. SOP
Conducted By : ________________
Status
Shortlisted
Not Shortlisted
C. Selection by Subject Matter Expert Acting Name of SME
:____________________________
Height
:_______ Ft __________ Inches
Weight
:__________________ Kgs
Direction / Production / Editing / Sound Design / Script Writing / Cinematography / Other Name of SME
:_____________________________
Feedback
:_____________________________
___________________________________________
Any Visible Scar :_____________________________
___________________________________________
Feedback
___________________________________________
Audition
:____________________________ Shortlisted
Not Shortlisted
Signature of SME / Interviewer __________________ Overall Selection Status:
Select
Shortlisted
Not Shortlisted
Signature of SME_____________________________
Reject
Comments:
Name of the Counselor_____________________
Name of the Centre Director____________________
ICE, Balaji Telefilms Ltd., Loadstar Building, Killick Nixon Compound, Saki Vihar Road, Nr. Chandivali Petrol Pump, Andheri (E)-72.