A. Name in full (in capital letters) Shri/Shrimati/Kumari

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1 Form No. NATIONAL SCHOOL OF DRAMA Bahawalpur House, Bhagwandas Road, New Delhi Telephones: (+91-11) , APPLICATION FORM 2017 (THREE YEAR DIPLOMA COURSE IN DRAMATIC ARTS) Please affix a passport-size colour photograph here, and attach 3 additional photographs to the application form The Selection Committee will form its first impression of you through this form. Therefore, please make sure that it is neatly filled in, preferably typed. Be precise and factual; give only relevant information; make no exaggerated claims. Applications incomplete in any respect will not be considered. A. Name in full (in capital letters) Shri/Shrimati/Kumari Date of birth / / Age as on 1/7/2017 years months days Nationality/ Male / Female/ Present address (in capital letters) City District State Pin Phone no. Permanent address (in capital letters) City District State Pin Phone no. Mobile No. Mother s name Father s name Address ) City District State Pin Phone no. Mobile No. (in capital letters) (Kindly provide your address for speedy communication)

2 Father s/mother s profession, and his/her annual income Whether SC/ST/OBC/PwD (attach documentary proof, duly verified) Married/Unmarried If married, husband s/wife s name and address City District State Pin Phone no. Mobile No. Husband s/wife s profession and his/her annual income Number of children, if any Contact phone no. B. KNOWLEDGE OF LANGUAGES Can speak fluently Can read fluently Can write fluently ACADEMIC QUALIFICATIONS (Attach attested copies. Certificate/Degree/Scheme Year University/Board/Institute Marks obtained (%) Main subjects High School Intermediate Graduation Postgraduation Training, if any

3 THEATRE EXPERIENCE Direction Mention any 6 major productions the applicant has directed. (Attach separate sheets for more productions.) Name of play Language Place/Occasion Author/Playwright Year Acting Mention any 6 major roles the applicant has performed. Name of play Language Author/Playwright Directed by Role Stage Craft Mention any 6 major productions in which the applicant was actively involved in stage design, set construction, lighting, costume design, make-up, stage management, etc. Name of play Author/Playwright Nature of Work Year WRITING SKILLS Plays Name of play Language Full-length/One-act Staged/Not staged Attach separate sheet if needed. Poetry Stories Novels

4 OTHER QUALIFICATIONS Any previous training in theatre? If yes, its nature Any previous training in dance, music (vocal/instrumental), visual art? Any other qualifications ORGANISATIONS ASSOCIATED WITH Name of the organisation Professional/Amateur Since when In what capacity C. PROFESSIONAL BACKGROUND Present occupation Annual income Experience of other jobs, if any Whether recipient of any scholarship while undergoing training, etc. If recipient of any scholarship, mention: (i) Amount of monthly scholarship (ii) Scholarship received from which date (iii) Source of scholarship D. PREVIOUS ATTEMPTS Have you applied to this course previously? How many times? (Mention year/s.) Preliminary interview Final interview/workshop E. STATE OF HEALTH (i) Are you physically fit to undertake theatre practice for long hours? (ii) Have you undergone any training in physical fitness? If yes, mention details. (iii) Your height and weight ( )

5 F. REFERENCES At least 3 eminent persons in the theatre field, not related to the applicant but familiar with his/her work, should be mentioned, and certificates given by them should be attached with this application. Name Address Status GENERAL/ Plans after training Any other information I have read the rules of the National School of Drama and agree to abide by them. I have attached DD No. for Rs 150/- dated issued by (bank s name) with application form. I affirm and agree to fulfil the scholarship contract/obligation of internship, of serving the National School of Drama on a one-year fellowship/honorarium/extended contract basis, in any of the wings of the School, for field and/or research work as may be assigned to me by the School. Date Signature of Applicant INDICATE YOUR FIRST, SECOND & THIRD preference of area of specialization from 2 nd year onwards by writing 1,2 & 3 in the boxes given below. Acting Direction Theatre Technique & Design CENTRES OF PRELIMINARY INTERVIEW Indicate your first and second preferences by writing 1 and 2 for any two centres of your choice: Guwahati Kolkata Bhubaneswar Chennai Bengaluru Bhopal Mumbai Lucknow Chandigarh Delhi

6 CHECK LIST Note: Please tick-mark the square applicable to you and sign in the appropriate space below: Have you attached self attested copies of certificates and degrees of examination passed? Have you attached a self attested copy of the certificate of High School or Matric or equivalent examination in support of your age? Have you attached three additional passport-size colour photographs? Have you attached certificates from three eminent persons in the theatre field testifying to your experience in theatre? Have you attached documentary proof of your theatre experience? Please send your application form in the attached envelope by speed post. In case of foreign nationals the applicant should apply through the Indian Embassy in his/her country and the Director General, Indian Council for Culture Relations, Azad Bhawan, New Delhi Signature of Applicant/ Name of the Applicant Contact phone no: Contact Mobile no: FOR OFFICE USE ONLY Interviewed on Report of interview Admitted/Not Admitted Director

7 W.P. (c) Undertaking (To be filled in by the applicant and submitted along with the application, duly signed) I, son/daughter of resident of, hereby undertake that in the event of my selection to the Diploma course in the National School of Drama, I hereby vouch for my good conduct and assure that I will not indulge in any kind of ragging. In case the authorities find me violating the instructions issued by the School in this regard, apart from the criminal legal action which will be initiated as per law, the School authorities will also be at liberty to take appropriate action against me as provided in the instructions. The School has also made me understand the relevant portion of the order of the Supreme Court of India in W.P.(C) No. 656/1998 dated and this undertaking is being given pursuant to the above order. Name and Signature of Student Address

8 W.P. (c) Undertaking (To be filled in by the parent/guardian of the student and submitted along with the application, duly signed) I, father/mother of resident of, hereby undertake that in the event of my son/daughter s selection to the Diploma course in the National School of Drama, I hereby vouch for my son/daughter s good conduct and assure that my son/daughter s will not indulge in any kind of ragging. In case the authorities find my son/daughter s violating the instructions issued by the School in this regard, apart from the criminal legal action which will be initiated as per law, the School authorities will also be at liberty to take appropriate action against my son/daughter as provided in the instructions. The School has also made my son/daughter understand the relevant portion of the order of the Supreme Court of India in W.P.(C) No. 656/1998 dated and this undertaking is being given pursuant to the above order. Name and Signature of Parent Address

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