This form is to be filled out by the director of the project. Once you have received an email confirmation of your online application, you MUST sign it and send it to complete your application. Please ensure you have read the guidlines before completing this application form. * Required

Title of Project

Title DR MISS MR MRS MS Please select

First Name *

Last Name *

Address *

Suburb *

State *

Postcode *

Country * -- Select Country -- AFGHANISTAN ALAND ISLANDS ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BOUVET ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO CONGO, THE DEMOCRATIC REPUBLIC OF THE COOK ISLANDS COSTA RICA CÔTE D'IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN TERRITORIES GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUERNSEY GUINEA GUINEA-BISSAU GUYANA HAITI HEARD ISLAND AND MCDONALD ISLANDS HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN, ISLAMIC REPUBLIC OF IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JERSEY JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, REPUBLIC OF KUWAIT KYRGYZSTAN LAO PEOPLE'S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTENEGRO MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PALESTINIAN TERRITORY, OCCUPIED PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIAN FEDERATION RWANDA SAINT BARTHÉLEMY SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT MARTIN SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SERBIA AND MONTENEGRO SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS SPAIN SRI LANKA SUDAN SURINAME SVALBARD AND JAN MAYEN SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TIMOR-LESTE TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES UNITED STATES MINOR OUTLYING ISLANDS URUGUAY UZBEKISTAN VANUATU VENEZUELA VIETNAM VIRGIN ISLANDS, BRITISH VIRGIN ISLANDS, U.S. WALLIS AND FUTUNA WESTERN SAHARA YEMEN ZAMBIA ZIMBABWE

Primary Phone Number *

Work Phone Number

Mobile Phone Number

Email Address *

Date of Birth

Gender * -- Please select -- Male Female Other

Please select below if you wish to be considered for the Aboriginal/Torres Strait Islander, Multicultural or Regional NSW First Break Funding: I am of Aboriginal or Torres Strait Islander descent I am from a multicultural background I reside in regional NSW

My cultural background is:

ATTACHMENTS

Attach Files (.pdf, .doc, 100Mb Limit) A current script - does not need to be at final draft stage*

A one-line AND one paragraph AND one page synopsis*

Director’s Statement [half page max]*

Bio/CV [one page max]*

Short bio of key crew if known [half page max]*

A brief statement outlining target audience and distribution plan [half page max]*

A signed Writers Agreement assigning all rights to the script to be developed and produced to the director from the screenwriter [Download writer's agreement]*

EDUCATION

What is the highest level of education you have completed? High School Certificate to Advanced Diploma Bachelor Degree or Higher Other

If 'Other', please specify:

EMPLOYMENT

Of the following categories, which best describes your current employment status? -- Please select -- Employed Full Time Employed Part Time Unemployed

If working, are you employed in a screen related sector? Yes No

If no, do you aspire to work in the screen sector Yes No

WHERE DID YOU HEAR ABOUT THE FIRST BREAK PROGRAM?

Please select one * Guide booklet Website eNews Network eNews Other eNews Online search Newspaper/Magazine Radio TV Referral/Word of Mouth Other

If 'Other eNews', please specify

If 'Online Search', what keywords did you use?

If 'Newspaper/Magazine', please specify

If 'TV', please specify

If 'Radio', please specify

If 'Other', please specify

Do you have a disability? Yes No

If yes, please specify:

ELIGIBILITY

I declare that: * I am a resident of New South Wales and am an Australian citizen I have not previously had a screened writer/director credit [REFER TO GUIDELINES] I am available to attend the tailored training course as outlined I have read understand and agree to the application guidelines I understand this application will only be complete after receipt of supporting material and printed version of the confirmation email and the completed application form I will receive via email I declare that I exclusively possess the screenwriting rights for the submitted project

Metro Screen eNews Subscription I have already subscribed

Subscribe to: Metro Screen Weekly eNews