MINDSCREEN FILM INSTITUTE (MFi) APPLICATION NUMBER
4, Ranga Lane, Ranga Road, Mylapore, Chennai - 600004
Ph: +91 44 42108682 / 24996417/Mobile: +91 9841612595 /7550142159
WILL BE ALLOTED BY MFi
Web: www.mindscreen.co.in /E-mail: mindscreen@mindscreen.co.in
APPLICATION FORM
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 YOUR PASSPORT SIZE
ONLY XEROX COPIES OF DOCUMENTS TO BE ATTACHED PHOTOGRAPH
AGE PROOF (BIRTH CERTIFICATE/SCHOOL LEAVING CERTIFICATE/DRIVING
LICENCE.)
PROOF OF IDENTITY (PHOTO PAN CARD / VALID PASSPORT /VOTERS
IDENTITY CARD OR AADHAR CARD)
REGISTRATION AND APPLICATION FEE*.
STATEMENT OF PURPOSE.
CANDIDATES APPLYING FOR ACTING COURSE SHOULD ATTACH FIVE
PHOTOGRAPHS: HEAD SHOT, CLOSE UP, MID SHOT, FRONT FULL & PROFILE
REGISTRATION AND APPLICATION FEE*(Payment by DD or Bank transfer for outstation and International
APPLICANT’S DRIVING LICENCE NO
Students).The registration and application fee of Rs.2500.00 inclusive of service tax is non – refundable and all
payments to be made favoring MINDSCREEN FILM INSTITUTE, CHENNAI along with this duly filled in application.
*REGISTRATION AND APPLICATION FEE PAYMENT (PLEASE TICK THEAPPROPRIATE BOXES)
BANK TRANSFER DEMAND DRAFT CHEQUE CASH OTHERS
FOR OFFICE USE (REGISTRATION AND APPLICATION FEE CONFIRMATION)
RECEIPT NUMBER: DATED: Rs. MODE OF PAYMENT:
CHOICE OF SPECIALIZATION (PLEASE TICK THEAPPROPRIATE BOXES)
NINE MONTHS COURSE IN CINEMATOGRAPHY
SIX MONTHS COURSE IN CINEMATOGRAPHY
SIX MONTHS COURSE IN FILMMAKING & DIRECTION
SIX MONTHS CERTIFICATE COURSE IN ACTING
APPLICANT’S PERSONAL DETAILS
FIRST NAME MIDDLE NAME SURNAME SEX
M F
APPLICANT’S E-MAIL ID: MOBILE (WhatsApp Number):
APPLICANT’S DRIVING LICENCE NO: APPLICANT’S PASSPORT NO
APPLICANT’S VOTER ID NO: APPLICANT’S AADHAAR CARD NO: BLOOD GROUP:
CONTACT AND COMMUNICATION ADDRESS OF THE APPLICANT
MAILING ADDRESS PERMANENT ADDRESS
PAGE 2
DETAILS OF EDUCATIONAL QUALIFICATION FROM HSC/MATRICULATION /SSLC/SSC ONWARDS
EXAMINATION UNIVERSITY/BOARD/ SUBJECTS YEAR OF % DIVISION/
PASSED INSTITUTION/COLLEGE PASSING MARKS CLASS/GRAD
S E
APPLICANT’S LANGUAGE SKILLS APPLICANT’S COMPUTER SKILLS
ADOBE PHOTO SHOP ADOBE PREMIERE MS OFFICE
EXCELLENT EXCELLENT EXCELLENT
GOOD GOOD GOOD
AVERAGE AVERAGE AVERAGE
POOR POOR POOR
OTHER SKILLS (PLEASE TICK)
DIGITAL PHOTOGRAPHY (DSLR) EXCELLENT GOOD AVERAGE POOR
VIDEO EDITING EXCELLENT GOOD AVERAGE POOR
SOUND RECORDING EXCELLENT GOOD AVERAGE POOR
IMAGE EDITING EXCELLENT GOOD AVERAGE POOR
WHETHER STUDIED EARLIER IN ANY OTHER FILM INSTITUTE? IF YES NAME AND ADDRESS OF
THE INSTITUTE AND SPECIALIZATION
HAVE YOU ATTENDED ANY FILM FESTIVAL? IF YES PLASE FURNISH DETAILS
HAVE YOU ATTENDED ANY WORKSHOP OR SEMINAR? IF YES, PLEASE SPECIFY
IF EMPLOYED, PLEASE FURNISH YOUR EMPLOYMENT DETAILS
ARE YOU RELATED TO ANYBODY IN THE FILM INDUSTRY? IF YES PLEASE FORNISH DETAILS
ON COMPLETION OF THE COURSE, HOW DO YOU INTEND TO GET INTO THE FILM INDUSTRY?
YES NO
PAGE 3
SHORT FILM, MUSIC VIDEO, DOCUMENTARY WRITTEN/DIRECTED OR SHOT BY YOU
ANY AWARDS WON BY YOU?
STATEMENT OF PURPOSE TO WHY YOU WISH TO TAKE UP A CAREER AS A CINEMATOGRAPHER
/SCREENWRITER /DIRECTOR or ACTOR IN 200 WORDS STRICLY.
PARENT’S /GAURDIAN’S PERSONAL INFORMATION (TO BE FILLED IN COMPULSORILY)
PARENT’S /GAURDIAN’S NAME
PARENT’S /GAURDIAN’S NAME
OCCUPATION
PARENT’S /GAURDIAN’S ANNUAL INCOME
ADDRESS FOR COMMUNICATION OF YOUR PERMANENT ADDRESS FOR COMMUNICATION OF
PARENTS YOUR PARENTS
PARENT’S /GAURDIAN’S E-Mail ID:
PARENT’S /GAURDIAN’S MOBILE No: PARENT’S /GAURDIAN’S LANDLINE No:
DECLARATION
I solemnly affirm that the information given in this application is true to the best of my knowledge and belief. I
understand that the decision of the institute is final with regard to the admission and assignment to a particular
course of study. If selected for admission, I promise to abide by the rules, regulations and directives of the Institute and
pay all applicable fees before commencement of the course.
SIGNATURE OF THE APPLICANT: Date:
Place:
