Screen Tasmania
Application Form
3.0Project Development Program
3.4 New Writers Fund
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 relevantproject development guideline3.4New Writers Fund plus theGeneral GuidelinesandTerms 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.
Applicant Details
Applicant type / Individual Company Partnership
Other (please specify) ......
(* to check boxes, double click in the box you wish to select, this opens a dialogue box and under default value, select ‘checked’ and hit ok)
Applicant name (Contracting entity)
1. Individual name / Title: / First Name: / Surname:
or 2.Company/Partnership name
Is the applicant a Tasmanian resident/Tasmanian resident production company / Yes No
Applicant/contracting entity’s ABN
Is the applicant/contracting entity registered for GST / Yes No
Postal address / Postcode
Street address / Postcode
Contact phone / Mobile
Email / Website
Contact person 1: same as applicant (if individual) / Yes No
If no, please provide the following:
Contact 1 / Title: / First Name: / Surname:
Contact phone / Mobile
Email
Contact 2 / Title: / First Name: / Surname:
Contact phone / Mobile
Email
Primary contact / Contact 1 Contact 2

SECTION B : PROJECT SUMMARY
Project title
Project synopsis (this section must be competed - maximum of 4 lines)
Which fund are you applying for?
Project Type
Feature Film / Telemovie / Television Drama Series
Television Comedy Series
Television Animation Series
Delivery Platforms (tick one or more)
Cinema release / Television broadcast / Website
Subscription TV / DVD / Wireless / mobile
Other (please specify)
Number of episodes / Duration / (minutes)
Genre
Circa
Setting
Indigenous story content (if yes, an additional copy of the script is required) / Yes No
SECTION B : PROJECT SUMMARY cont’d
Please indicate the censorship rating you aim to obtain for the project
Cinema G PG M MA 15+ R 18+ X 18+
Television P C G PG M MA 15+ AV 15+
Who is the audience for the project?
Will the project be made in Tasmania? / Wholly Partly
Please provide details:
Do you have any marketplace interest in this project? Yes No
Please provide details
Estimated time to complete the next development stage
Please list the proposed deliverables for next stage
SECTION C : CREATIVE TEAM
Creative team
Please specify the names of the team and place of residence (state or country) and indicate whether proposed (P) or confirmed(C)
Role / Name / Residence / Proposed/Confirmed
Executive producer / P C
Producer / P C
Director / P C
Please list recent produced credits for the Producer
Project Name / Type / Role / Duration / Year
Please list recent produced credits for the Director
Project Name / Type / Role / Duration / Year
Please list recent produced credits for the Executive Producer
Project Name / Type / Role / Duration / Year
SECTION D : FINANCIAL INFORMATION
Estimated budget for this stage of development / $
Amount sought from Screen Tasmania / $
Has this project been considered by Screen Tasmania previously? / Yes No
If yes, please provide details
Date / Stage / Project Title / Amount requested/funded / Funded
$ / Yes No
$ / Yes No
Has this project been previously submitted to any funding bodies for development funding? / Yes No
If yes, provide details
Date of application / Name of funding body / Amount requested/funded / Status
$
$
$
Copyright information
The applicant must be the originator of the script or treatment concerned, or the holder of the copyright, or have an option to the rights in any and all works on which the project is to be based. Evidence of copyright must be submitted with this application. Screen Tasmania will only contract with copyright holders of the works.
Name(s) of originator
Is the work an original idea of yours (the applicant)? / Yes No
If yes, please provide statement of copyright
If no, have you (the applicant) acquired all rights from the copyright owner/co-writers? / Yes No
Is this partly or wholly based on a real person/event? / Yes No
If yes, please attach details on a separate sheet including relevant permissions and clearances.
SECTION E : CHECKLISTS
New Writers Fund
Feature Film
Please submit one electronic copy and two hard copies of the following:
a completed application form
a logline
a one paragraph synopsis (maximum eight lines)
a one to two page synopsis
first 15 pages of completed draft script
a completed project history, next stage notes and script analysistemplates
a statement of copyright and chain of title documents (if the work is based on an underlying work by a person other than the applicant)
a statement articulating the economic and cultural benefits of the project to Tasmania
the curriculum vitae of the applicant.
Television Fiction
Please submit one electronic copy and two hard copies of the following:
a completed application form
a logline
a one paragraph synopsis (maximum eight lines)
synopses for a minimum of three episodes, concept outline, character breakdowns, and outlines of style and genre
first 15 pages of completed draft script
a completed project history, next stage notes and script analysistemplates
a statement of copyright and chain of title documents (if the work is based on an underlying work by a person other than the applicant)
a statement articulating the economic and cultural benefits of the project to Tasmania
the curriculum vitae of the applicant.

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 theRight 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 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 and my colleagues on the project) do nothave a financial and/or close personal relationship with a board member or employee of Screen Tasmania.
I (the applicant and my colleagues on the project) 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.
Do you identify as having a disability? / Yes No
If yes, please provide further details.