Attachee’s Application Form
SECTION A : GENERAL INFORMATION
Applicants must make contact with a Screen Tasmania project officer prior to submitting applications. The allocation of project officers is subject to availability and workload.
This application form should be completed in compliance with Screen Tasmania’s 4.1a Professional Development silverScreen Gold Pass Guidelines, General Guidelines and Terms of Trade. Please refer to these guidelines for the specific requirements of your application.
Please provide the name of the Screen Tasmania Project Officer with whom you have discussed your application.
Proposed attachee details
Proposed attachee / Title: / First Name: / Surname:
Professional level / Experienced Emerging
Attachee’sABN
Is the attachee registered for GST / Yes No
Postal address
Street address
Contact phone / Mobile
Email / Website

SECTION B : ATTACHMENT DETAILS
Are you applying:
1. As an individual with a letter from a production company / 2. As an individual in response to a Screen Tasmania call out
Attachment Details:
Host Production Company / Name of Production (s) / Attachment Supervisor / Genre / Format / Stage(s) of Production during attachment / Role(s) of attachee / Duration of attachment
Attachment Supervisor Details:
Title: First Name: Surname:
______
Production role:
______
Contact phone: mobile: Email
______
Please add any further details relating to the type, purpose and duration of the proposed attachment (e.g. is some of the attachment involve working from home on scripts,
Rationale or vision statement
Please describe how this attachment will contribute to your (or your selected attachee’s) professional development and career goals.
Outcomes (for individuals – boxes 1 and 2 - only)
Please outline what you would like to achieve, and what you could contribute to the production. Please note - a person doing an attachment will be expected to be involved in the development / production activities and not just be an observer.
What you would like to achieve? / Skills you could contribute/jobs you could undertake
1.
2.
3.
4.
Please confirm that you (as an individual) have read and understood the Screen Tasmania ‘Attachments: On-set Etiquette’ document. Yes
Previous industry experience(for all individuals)
Please list the productions in which you have taken part and the roles you have performed in those productions.
Type of production / Name of production / Your role
SECTION C : FINANCIAL INFORMATION
Budget (for all applications)
Please outline your funding request. Please see the4.1a Professional Development silverScreen Gold Pass Guidelines for more details and funding caps.
Name of Attachee / Date(s) of attachment
Start End / No. of weeks / Accommodation
Cost (@$100 per day) / Per -Diems
(@ $60 per day) /
Host Company Payments to attachee
(@$500 per week) / Flights*
$ / $ / $
TOTAL / $

*NOTE: Airfares (payment to Attachee of $300 [Mel] or $400 [Syd]).

SECTION E : CHECKLIST

Please submit one electronic copy and one signed hard copyof the following:

a completed application form

CV

any supporting documents providing evidence of previous experience, track record, prior training, screenings awards, etc. (individuals)

insurance documents (if applicable)

letter of offer from host company(if applicable)

Please send electronic submission to:


SECTION F : DECLARATION & SIGNATURE
Publicity of Assistance
Unlike private sector financial organisations, the Department of Economic Development, Tourism and the Arts (the department) disburses public funds and is therefore accountable for the distribution of those funds. As part of the accountability process, the department may publicise the level of its financial assistance including the terms and conditions of the financial assistance as provided in the confidentiality requirements set out in the legal documentation entered into with you.
Right to Information
You should also be aware that information you provide to the department, and details of any financial assistance package, may be subject to requests for public disclosure under the Right to Information Act 2009 provided that information is not subject to the confidentiality requirements set out in the legal documentation entered into with you.
Personal Information Protection

Personal information will be collected from you for the purpose of undertaking the department’s activities. Your personal information will be used for the primary purpose for which it is collected and may be used for other purposes permitted by the Tasmanian Development Act 1983 and/or the Crown may be disclosed to contractors and agents of the department or affiliated bodies, and other organisations authorised to collect it.

Your basic personal information may be disclosed to other public sector bodies where necessary for the efficient storage and use of the information.

Personal information will be managed in accordance with the Personal Information Protection Act 2004 and may be accessed by the individual to whom it relates on request to the department’s personal information protection officer on (03) 6233 5888. You may be charged a fee for this service.

Have you read and understood the confidentiality regulations above? / Yes No
Screen Tasmania is required to identify all relevant financial or personal interests that may exist between board members or employees of Screen Tasmania and applicants. This is to ensure that measures can be introduced to prevent a conflict of interest arising between those persons assessing the application for Screen Tasmania and such applicant. For these purposes please select the relevant statement below:
‘I (the applicant) do nothave a financial and/or close personal relationship with a board member or employee of Screen Tasmania.
I (the applicant) dohave a financial and/or close personal relationship with a board member or employee of Screen Tasmania. The nature of such relationship is:
I/we acknowledge this submission in no way inhibits or prejudices Screen Tasmania from becoming involved in or developing other projects which may or may not have various similarities with my project.
No agreement, arrangement or obligation shall be deemed to exist between Screen Tasmania and myself/us unless and until a formal contract is made between us.
SECTION F : DECLARATION & SIGNATURE cont’d
I/we are aware that in the event of this application being approved, no contracting will occur until Screen Tasmania has been provided with copies of executed documents giving the contracting party the right to exploit the material being the subject of the application either by way of assignment of copyright or an opinion.
I/we state the details provided in this application are true and correct.
Signature / Print name
Signature / Print name
Witness / Print name
Date / ……..…/……..…/……..…

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SECTION G : STATISTICAL DATA
Screen Tasmania is compiling statistics on applications for its funding programs. To assist us, we appreciate the completion of the form below and return it with your application.
This information is removed prior to processing of applications and is only used to generate aggregated statistics.
Date of application / ……..…/……..…/……..…
Gender / Female Male
Country of birth
If you are a Tasmanian resident, what area of the state do you reside in?
Are you of Aboriginal or Torres Strait Islander descent? / Yes No
Do you speak a language other than English at home? / Yes No
If yes, please specify language/s spoken at home.
How well do you speak English? / very well well not well not well at all
Do you identify as having a disability? / Yes No
If yes, please provide further details.