Cultural Cinema Exhibition Course Application Form

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					                       Cultural Cinema Exhibition 2010
                       Course application form (Europeans outside UK)

Please type or write in block capitals. Please fill in the form in English and translate any job titles,
course titles etc into English.

Full name:


Address:                                              Daytime telephone:
                                                      Email:
Country of residence:


Job title:
Employer:


Universities attended and degrees held:
University             Dates       Title of degree and major subjects covered                  Grade




Professional and voluntary experience relevant to your application:
(Participants must have relevant film industry experience - this can be paid or voluntary
and does not have to be continuous)
Job title            Employer              Dates        Main responsibilities
How will taking this course help your professional development?




Which fees option are you applying for? (please see fees information on the website)

      Fees only                                 Part Scholarship (residential)
      Residential option                        Full Scholarship (residential)
                                                Non-residential scholarship

If you are applying for a Scholarship, please read ‘Scholarship guidelines – Europeans
outside UK’ downloadable from the website and explain how you fulfill the priority criteria
and what circumstances make you feel you are qualified to get a Scholarship




How did you hear about this course?

    ICO website                                     MEDIA
    Email from the ICO                              Europa Cinemas
    Flyer (where from?)                             Word of mouth
    Other (please specify)
Do you have any dietary requirements?



Do you have any access requirements we should be aware of? Please give details




     Please tick to confirm that your level of spoken English is high or fluent

Signature of applicant: ________________         Date: __________

Please return this form by email to: sarah@independentcinemaoffice.org.uk.

You should receive an email within 7 days to confirm receipt of your application.
If you are accepted onto the course, you will need to pay your fees to confirm your place,
otherwise your place may be reallocated if the course is oversubscribed – so please
ensure you have funds available. No refunds will be available after 23 December 2010.
Cultural Cinema Exhibition 2010
Equal opportunities monitoring form

The Independent Cinema Office aims to ensure that training is available to everyone
regardless of age, gender, race, ethnic or national origin and disability.

This information is required by the funders of our training projects so please do take the
time to complete this form. The information will be used to compile anonymous statistical
information only.

1. I am:     Male             Female

2. Do you identify as disabled?     Yes                No

3. I am: Under 19        19-26        27-39       40-49       50-59        60 or over

4. My nationality is: ……………………………………………..

4. I would describe my ethnic origin as:

     A: White                                        D: Black or Black British
         British                                         Caribbean
         Irish                                           African
     Any other White background:                     Any other Black background
    ……………………………………..                               ………………………………………….
     B: Mixed                                      .
        White and Black Caribbean                    E: Other Ethnic Groups
        White and Black African                          Chinese
        White and Asian                                  S.E. Asian
     Any other mixed background                          Middle Eastern
    ……………………………………..                                     Latin American
     C: Asian or Asian British                       Any other
         Indian                                    ……………………………………..
         Pakistani
         Bangladeshi
     Any other Asian Background
    …………………………………………..


  Please return this form to: sarah@independentcinemaoffice.org.uk or
  ICO, 3rd Floor, Kenilworth House, 79-80 Margaret Street, London W1W 8TA, UK

				
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Description: Cultural Cinema Exhibition Course Application Form