APPLICATION FORM

Name

First Name Middle Name Last NameDate of Birth Gender Languages Known

Address for correspondence (in BLOCK Letters)

City Pincode State

Residence Number Mobile Number Email Id

Marital Status : Single Married

Education Qualification [Highest Education]

Qualification University / Board Year of Passing Specialization Subjects Percentage

Training in Media and Entertainment

Name of Course Institute / Academy Year of Passing Specialization

Total Work Experience (Descending Order)

Period Worked Name of Organisation Position

From To

Work Experience in Media and Entertainment

Period Worked Name of Organisation Position

From To

Have you attended any Auditions. If yes, kindly mention details below

Month of Audition Name of the Production House / Project Selection Status [Selected / Not Selected]

D D M M Y Y Y Y M F

Monthly Family Income

Below Rs.15,000/-

Rs.15,000/- to 25,000/-

Rs.25,000/- to 40,000/-

Rs.40,000/- & above

SL. ICE/AF/BOM/_______ DATE:______________Hello and Welcome to ICE.Provide all information requested in this form which will help us guide you to the program that best suits you. Make all entries in BLOCK Letters.

C. Selection by Subject Matter Expert

I came to know about ICE through (Tick Appropriate)

Emailer Hoonur

Relative / Friend TV

Internet Attended a Seminar / Presentation at School / College

Hoarding / Kiosk / Poster / Banner At an Audition

Received a call from ICE Newspaper AD

Paper Insert Radio Ad

Course Interested in (Tick Appropriate)

Acting Direction Script Writing Editing Cinematography Production Sound Recording

Others

While counseling I would like ICE Counselor to emphasize on

Course Content Live Environment Faculty Credentials Duration Fees

DECLARATION TO BE SIGNED BY THE APPLICANT

I do hereby declare that all the statements made in the above form are true, complete and correct to the best of my

knowledge and belief.

Place: _______________________ ________________________

(Signature of the Applicant)

Direction / Production / Editing / Sound Design / Script Writing / Cinematography / Other

Name of SME :_____________________________

Feedback :_____________________________

___________________________________________

___________________________________________

___________________________________________

Shortlisted Not Shortlisted

Signature of SME_____________________________

Acting

Name of SME :____________________________

Height :_______ Ft __________ Inches

Weight :__________________ Kgs

Any Visible Scar :_____________________________

Feedback :____________________________

Audition Shortlisted Not Shortlisted

Signature of SME / Interviewer __________________

Overall Selection Status: Select Reject

Comments:

Name of the Counselor_____________________ Name of the Centre Director____________________

------------------------------------------------- For Office Use -------------------------------------------------

A. Interview Conducted By : ________________ Status Shortlisted Not Shortlisted

B. SOP Conducted By : ________________ Status Shortlisted Not Shortlisted

ICE, Balaji Telefilms Ltd., Loadstar Building, Killick Nixon Compound, Saki Vihar Road, Nr. Chandivali Petrol Pump, Andheri (E)-72.