3D for camera professionals: application form
Please answer all questions as fully as possible
First Name ………………………………. Surname…….……………….…………………………
.
Address …………………………………………………………………………….……………………..
Postcode ………………………………… Borough/County ………………………..……………
Telephone…..………………………………… Mobile……………………………………………………
Email…………………………………………………………………………………………………….…………
Age ………………… Date of birth ………………… Male……………Female……………
1. Your work
Are you a freelancer/company working in the creative media industry? Yes / No
What is your department/specialism?
How many years have you been working in the industry? ……………………………..
Are you currently employed? Yes / No
If ‘No’ how many months have you been unemployed? ………………………………………..
Roughly how many months have you worked during the last year? …………………..
Have you attended any training courses during the past 2 years? Yes / No
If yes, where was the training, and what did it cover?
2. Why are you applying for this training course? What do you hope to gain from it?
3. Please indicate which course you would like to apply for
Day / Dates / Location / Cost / Please tickCourse one / 11-13 June 2012
10am-5pm / Four Corners
121 Roman Road
London E2 OQN / £330.00 plus VAT
Course two / 1-3 October 2012
10am-5pm / Four Corners
121 Roman Road
London E2 OQN / £330.00 plus VAT
4. Do you have any specific access needs? If yes, please provide details.
5. Hardship. We aim to make this course accessible for all. If you believe you have a case of real hardship with the course fees, please attach a letter providing details and evidence. This can also include issues of childcare, travel and accommodation costs. We will consider all reasonable requests.
6. Have you attended a Four Corners course before? Yes/No
If yes, which course and when?
7. Where did you hear about this scheme/Four Corners?
10. Please sign and date this application
I declare that the details given on this application form are true to the best of my knowledge.
Signature: Date:
Please return to Four Corners with a copy of your current CV, and complete the statistical information on the next page.
Four Corners
121 Roman Road
London E2 OQN
T. 020 8981 6111
www.fourcornersfilm.co.uk
This scheme has been funded by the Skillset Film Skills Fund as part of ‘A Bigger Future 2’, the UK film skills strategy. The Skillset Film Skills Fund is supported by the National Lottery through the BFI and the film industry through the Skills Investment Fund.
Statistical information: please complete
Please complete the following information for our funding requirements. The information you provide will be used to provide statistical data only.
Please circle the answers that apply to you.
Do you have a disability Yes No Prefer not to say
Do you have a long-term health issue (12 months plus) that affects your daily activities?
Which of the following groups do you belong to?
1. White - British 2. White – Irish
3. White – Other 4. Mixed White and Caribbean
5. Mixed – White and African 6. Mixed White and Asian
7. Mixed – Other 8. Asian or Asian British – Indian
9. Asian or Asian British – Pakistani 10. Asian or Asian British – Bangladeshi
11. Asian or Asian British – other 12. Black or Black British – Caribbean
13. Black or Black British – African 14. Black or Black British - other
15. Chinese 16. Other
17. Prefer not to say
What is the highest qualification you hold?
GCSE A level NVQ (note level) Undergraduate
Post graduate No qualifications Other (please specify)
1
121 Roman Road, Bethnal Green, London E2 OQN T. 020 8981 6111 F. 020 8983 7866
E. W. www.fourcornersfilm.co.uk