Application Form - Mindscreen Film Institute

MINDSCREEN FILM INSTITITE N0.4, Ranga Lane, Ranga Road, Mylapore, Chennai – 600 004 Phone: +91 44 4210 8682 / 2499 6417, Mobile: +919841612595, Fax: +91 44 2431 0655 E-mail: [email protected], Web: www.mindscreen.co.in ________________________________________________________________________________________________________________________

APPLICATION FORM THREE MONTHS FOUNDATION COURSE ON DIGITAL PHOTOGRAPHY _____________________________________________________________________________ CHECKLIST FOR FILLING UP THIS APPLICATION FORM           

APPLICATION TO BE FILLED IN LEGIBILY AND MUST BE COMPLETE. REQUIRED RELEVANT DOCUMENTS TO BE ATTACHED WITHOUT FAIL. ACADEMIC CERTIFICATES AND EXPERIENCE CERTIFICATE IF ANY. RECENT ONLY XEROX COPIES OF DOCUMENTS TO BE ATTACHED. PASSPORT SIZE AGE PROOF (BIRTH CERTIFICATE/SCHOOL LEAVING CERTIFICATE/DRIVING LICENCE.) PHOTOGRAPH PROOF OF IDENTITY (PHOTO PAN CARD / VALID PASSPORT /VOTERS IDENTITY CARD.) REGISTRATION AND APPLICATION FEE*. STATEMENT OF PURPOSE REGISTRATION AND APPLICATION FEE* (Payment by DD or Bank transfer for outstation and International Students).The registration and application fee of Rs.1000.00 inclusive of service tax is non – refundable.  All payments to be made favoring MINDSCREEN FILM INSTITUTE, CHENNAI along with this duly filled in application ____________________________________________________________________________________________________________ * REGISTRATION AND APPLICATION FEE PAYMENT (PLEASE TICK THE APPROPRIATE)

MODE OF PAYMENT DEMAND DRAFT

BANK TRANSFER

LOCAL CHEQUE

FOR OFFICE USE (REGISTRATION FEE RECEIPT CONFIRMATION)

RECEIPT NO APPLICANTS PERSONAL DETAILS

CASH DATED

1. Your Name: ________________________________________________________________2.Sex: MALE / FEMALE 3. Date of Birth: _________________4.Nationality:_________________5.Mother Tongue: ________________________ APPLICANT’S COMMUNICATION PARTICULARS 6. Permanent Address: _______________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 7. Address of Communication & Mailing Address: _________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 8. Applicants E-mail ID: _________________________________________9.Applicants Mobile No: ________________ 10. Applicants Driving License /Passport/ Aadhaar Card or Pan Card Number: __________________________________

-211. Applicants Language Skills: A) Read: __________________________________________________________________________________________ B) Write: __________________________________________________________________________________________ C) Speak: _________________________________________________________________________________________ 12. Applicants Computer Skills: A) ADOBE PHOTOSHOP: EXCELLENT / GOOD / AVERAGE / POOR B) ADOBE PREMIERE : EXCELLENT / GOOD / AVERAGE / POOR C) MS OFFICE : EXCELLENT / GOOD / AVERAGE / POOR 13. Applicants Educational Qualification: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 14. Have you attended any Photography workshop? If YES please specify: _____________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ 15. Self-assessment of your photography level: ____________________________________________________________ __________________________________________________________________________________________________ 16. Are you member of any photography group/club or organization: __________________________________________ _________________________________________________________________________________________________? 17. Does pictures available online in any public domain:__________________________________________________ _________________________________________________________________________________________________? 18. On completion of the course, do you intend to take up admission for the SIX MONTHS COURSE ON CINEMATOGRAPHY at MINDSCREEN FILM INSTITUTE: ______________________________________________? Declaration: I hereby certify that the information I have provided on this application form is complete and accurate to the best of knowledge and I am liable for disqualification or dismissal at any time if the stated information is found to be incorrect or misleading

SIGNATURE OF THE APPLICANT: __________________________________________________________________ DATE: _________________________ PLACE: __________________________________________________________