Applicants must make contact with a Screen Tasmania project officer prior to submitting applications. The allocation of project officers is subject to availability and workload.
This application form should be completed in compliance with Screen Tasmania’s 4.2 Professional Development Guidelines, General Guidelines and Terms of Trade. Please refer to these guidelines for the specific requirements of your application.
Please provide the name of the Screen Tasmania Project Officer with whom you have discussed your application.
Applicant Details
Applicant type / Individual Company Partnership
Other (please specify) ......
(* to check boxes, double click in the box you wish to select, this opens a dialogue box and under default value, select ‘checked’ and hit ok)
Applicant name (Contracting entity)
1. Individual name / Title: / Ms / First Name: / Surname:
or 2.Company /Partnership name
Is the applicant a Tasmanian resident/Tasmanian resident production company / Yes No
Applicant/contracting entity’s ABN
Is the applicant/contracting entity registered for GST / Yes No
Postal address / Postcode
Street address / Postcode
Contact phone / Mobile
Email / Website
Contact person 1: same as applicant (if individual) / Yes No
If no, please provide the following:
Contact 1 / Title: / First Name: / Surname:
Contact phone / Mobile
Contact 2 / Title: / First Name: / Surname:
Contact phone / Mobile
Primary contact / Contact 1 Contact 2
Please indicate the activity for which you are seeking support.
Course/Conference / Festival / Attachment
Please note: for support for business travel (i.e. you are meeting people to sell a project or arrange finance/distribution deals), please apply under Business Travel.
For Courses/Conferences and Festivals, please fill out Section B below. For Attachments, please fill out Section C.
SECTION B : COURSE/CONFERENCE/FESTIVAL
Description
Please describe briefly the event you wish to attend, including the name, location and dates of the event and in the case of festivals, the category or competition in which your project will be screening.
Rationale
Please describe how this event will contribute to your development.
Outcomes
Please outline the outcomes you will achieve and how you will achieve them.
Outcomes / How you will achieve them
1.
2.
3.
4.
5.
Additional Meetings (if arranged)
Please list any additional meetings which you have arranged.
Budget
Please outline your budget. You can only claim 50% of course fees/earlybird registration and 50% of airfares (if applicable). Please see the4.2 Professional Development Guidelines for more details and funding caps.
Event / Total Cost / Screen Tasmania Contribution(50%)
Registration Costs
Travel Costs
Total:
SECTION C : ATTACHMENTS
Are you applying:
1. As an individual with a letter from a production company / 2. As an individual in response to a Screen Tasmania call out / 3. A host company applying for attachment of a selected individual
Description of attachment (for individuals ticking box 2 – insert the name of the attachment as shown in the call out )
Please describe the type, purpose and duration of the proposed attachment.
Rationale
Please describe how this attachment will contribute to your (or your selected attachee’s) professional development.
Outcomes (for individuals only)
Please outline what you would like to achieve, and what you could contribute to the production. Please note, a person doing an attachment will be expected to help on a production and not just observe.
What you would like to achieve / Skills you could contribute/jobs you could undertake
1.
2.
3.
4.
(Please insert additional lines if you require more space)
Production Company
(If you are arranging your own attachment place, please attach a Letter of Offer from the production company.)
Name of Company / Attachment Description / Contact Person / Contact Details
Please note: Should you be successful in receiving Screen Tasmania support, the contracting entity must be the production company with whom you are seeking attachment.
If I’m applying as an individual, I confirm I have read and understood the Screen Tasmania ‘Attachments: On-set Etiquette’ document.
SECTION D : BACKGROUND – ALL APPLICATIONS
Previous Funding(individual and company applicants)
Please give details of any Screen Tasmanian funding support you have received in the past
Type of Production / Name of Production / Your Role
Please add more lines to this table, if you need them.
Previous Industry Experience (for individuals only)
Please list the productions in which you have taken part and roles you have performed in those productions.
Type of Production / Name of Production / Your Role
Attachments/Mentorships (for individuals only)
If you have already undertaken an Attachment or a Mentorship, please list the productions in which you have taken part.
Type of Production / Name of Production / Name of Mentor / Mentor’s role
SECTION E : CAREER GOALS
For individuals, please provide a statement of 350 words or less, outlining your long term career aspirations and how you aim to achieve them.
SECTION F : CHECKLIST
Please submit one electronic copy and one hard copyof the following:
a completed application form including a clear rationale and a statement of career goals
evidence of a commitment to a career in the screen industry
for interstate courses, conferences or festivals - a plan for meetings around or at the event
for festivals, evidence of selection
attachment letter of offer (if applicable)
a statement articulating the economic and cultural benefits to Tasmania of the proposed support.
Please send electronic submission to:
SECTION G : DECLARATION & SIGNATUREPublicity of Assistance
Unlike private sector financial organisations, the Department of Economic Development, Tourism and the Arts (the department) disburses public funds and is therefore accountable for the distribution of those funds. As part of the accountability process, the department may publicise the level of its financial assistance including the terms and conditions of the financial assistance as provided in the confidentiality requirements set out in the legal documentation entered into with you.
Right to Information
You should also be aware that information you provide to the department, and details of any financial assistance package, may be subject to requests for public disclosure under theRight to Information Act 2009 provided that information is not subject to the confidentiality requirements set out in the legal documentation entered into with you.
Personal Information Protection
Personal information will be collected from you for the purpose of undertaking the department’s activities. Your personal information will be used for the primary purpose for which it is collected and may be used for other purposes permitted by the Tasmanian Development Act 1983 and may be disclosed to contractors and agents of the department or affiliated bodies, and other organisations authorised to collect it.
Your basic personal information may be disclosed to other public sector bodies where necessary for the efficient storage and use of the information.
Personal information will be managed in accordance with the Personal Information Protection Act 2004 and may be accessed by the individual to whom it relates on request to the department’s personal information protection officer on (03) 6233 5888. You may be charged a fee for this service.
Have you read and understood the confidentiality regulations above? / Yes NoScreen Tasmania is required to identify all relevant financial or personal interests that may exist between board members or employees of Screen Tasmania and applicants. This is to ensure that measures can be introduced to prevent a conflict of interest arising between those persons assessing the application for Screen Tasmania and such applicant. For these purposes please select the relevant statement below:
‘I (the applicant) do nothave a financial and/or close personal relationship with a board member or employee of Screen Tasmania.
I (the applicant) dohave a financial and/or close personal relationship with a board member or employee of Screen Tasmania. The nature of such relationship is:
I/we acknowledge this submission in no way inhibits or prejudices Screen Tasmania from becoming involved in or developing other projects which may or may not have various similarities with my project.
No agreement, arrangement or obligation shall be deemed to exist between Screen Tasmania and myself/us unless and until a formal contract is made between us.
SECTION G : DECLARATION & SIGNATURE cont’d
I/we are aware that in the event of this application being approved, no contracting will occur until Screen Tasmania has been provided with copies of executed documents giving the contracting party the right to exploit the material being the subject of the application either by way of assignment of copyright or an opinion.
I/we state the details provided in this application are true and correct.
Signature / Print name
Signature / Print name
Witness / Print name
Date / ……..…/……..…/……..…
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SECTION H : STATISTICAL DATAScreen Tasmania is compiling statistics on applications for its funding programs. To assist us, we appreciate the completion of the form below and return it with your application.
This information is removed prior to processing of applications and is only used to generate aggregated statistics.
Date of application / ……..…/……..…/……..…
Gender / Female Male
Country of birth
If you are a Tasmanian resident, what area of the state do you reside in?
Are you of Aboriginal or Torres Strait Islander descent? / Yes No
Do you speak a language other than English at home? / Yes No
If yes, please specify language/s spoken at home.
Do you identify as having a disability? / Yes No
If yes, please provide further details.