Please refer to the MAKE Guidance Notesfor more information on how to fill out the application form.

The deadline for applications is Monday 27th April 2015, 5pm.

Section A – Contact Information

Please tell us about yourself so that we can contact you.

Name of MAKER
Date of Birth
Current Address
Daytime Telephone Number
Mobile Number
E-mail Address

Section B – Contacting Your Supporting Adult or Chosen Mentor

Your supporting adult (or mentor if you already have them identified) will be our adult contact should we not manage to be able to get in contact with you at any point in the programme. They will also be there to support the development of your work (offer advice, support and guidance).

Name of Supporting Adult/Chosen Mentor
Relationship to Maker
Current Address
Daytime Telephone
Mobile Number
Email Address

Section C – You and Your Work

Please tell us about your artistic experiences and ideas for your new work.

Describe your artistic experiences up to now (e.g. sessions taught in or out of school):
Describe your artistic experiences to date from other places, like dance/theatre groups or other relevant experiences and tell us what they are:
If this is not the first time you have made work, please tell us about a previous piece you have made.
Please tell us about your approach to making work.
How do you go about making new work, what interests you and what techniques do you use?
OR
If this is the first time you will be making work, please describe how you anticipate approaching the task and the skills you will use to create the work.
(300 words max)
What do you hope to gain from working with aprofessional mentor during this project?
Managing Your Work:
What experience do you have of making work with others for performance?
To ensure we can meet the needs of all participants, please tell us if you have any access requirements
Where do / will you rehearse with your performers?
How do you know the performers you hope to work with?
Please provide the following information for any dancers you currently expect to work with in your piece?
Name / Age on 2nd November 2012 / Male / Female / Contact Telephone no. / Email Address / Access Requirements

Can you attend the Selection Day on Saturday 2nd May 2015?

(Please delete as applicable)

YES

NO

Section D – The Makers Declaration

The Maker is to read the declaration and sign below:

I have read and understood the MAKE Information and Guidance Notes and have completed this form to the best of my knowledge.

I am available to make the selection day on Saturday 2nd May from 1pm.

Young Person signed: ______

Name: ______

Date: ______

Equal Opportunities Monitoring Form

Please submit this form with your application by 5pm on 2nd November 2012.

Ludus Dance welcomes applications from all sections of the community. You do not have to give us the following information but we would be very grateful as it will be used to monitor our success at implementing our equal opportunities policy. We will not use this information to assess your application.

1. Date of Birth: ______Age on 2nd November 2012: ______

2. Gender: ______

3. Please mark the box that applies to you:

Bangladeshi
Black – African
Black - Caribbean
Black – other
Black - British
Chinese
Dual Heritage
Indian
Irish
Pakistani
White – British
Other (please specify)

4. Do you consider yourself to have a disability? Yes No I prefer not to say

5. Do you consider yourself to have a long-term health condition?

Yes No I prefer not to say

6. Are you entitled to free school meals? Yes No

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