TheCornerEOI

Read and follow the instructions carefully prior to submitting your application.
I have read and understand the instructions.
All correspondence will be generated from the personal information submitted below. So, please use correct spelling, capitalisation and punctuation.
I. Contact details:

Tell us about yourself
First NameLast Name
Home Address :

Street Address

Street Address Line 2

CityState / Territory

Post CodeCountry
E-mail :
Where the confirmation will be send to
Mobile No. :

Area CodePhone Number
Telephone No. :

Area CodePhone Number
Birthdate:

MonthDayYear
Do you require assistance filling out this form?
If you answered Yes, what is the full name of person filling out this form

First NameLast Name
Relationship to applicant:
Mobile No. :

Area CodePhone Number
Telephone No. :

Area CodePhone Number
E-mail :
Where the confirmation will be send to
II. Dance Experience:
Short biography (200 words):

0/200
I am currently:
Dancing as a hobby (non-professional)?
If Yes, where?
Studying at a pre-tertiary / tertiary-level dance institution?
If Yes, where?
A recent graduate?
Course Attended / Attending:
Other:
Year of Graduation:
Working indpendently?
Working with a company?
Name of company:
Have you previously worked with Philip Channells ?
Have you previously worked with Gavin Webber?
III. Availability and Interest:
I wish to attend The Corner Dance Lab
I am available between Friday 15th - Saturday 23rd January 2016
I would like to attend only part of the residency
Dates available:
I am interested in disability-inclusive dance practice
I have specific access needs and would like to attend the The Corner Dance Lab with a friend / colleague / family member who will support me during the week.
Family member, Friend or Colleague?
Support person's name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Participant in the project
IV. Dance Practice:
I am interested in developing my own choreography with a mentor:
Comment:
V. Acceess Requirements:
Do you have a disability?
Comment:
Preferred method of contact
If Other, comment:
I have access requirements?
Comment:
I have medical requirements?
Comment:
I have dietrary requirements?
Comment:
I need transport assistance to Jasper Corner?
How do you plan to get to Federal?
I would like to discuss my access & transport needs, medical & dietary requirements and any other support needs I have through my preferred method of contact.
Comment:
VI. Financial Investment
Early bird EOI applications are eligible for $50.00 discount.
I would like to secure my place with an initial $100.00 payment
NOTE: A Financial Agreement Form will be emailed to you to once we have processed your application. Please check you have provided us the correct email account details.
Early Bird / EOI received before Fri 30 October 2015
General / EOI received between Sat 31 October – Sun 20 December 2015
I would like to apply for a payment plan.
I agree to pay in full by 5pm Monday 21 December 2015
VII. Additional information
Any additional information you would like us to know:

0/500
VIII. Authorisation and Consent
I have read and understood the information regarding The Corner Dance Lab 2016 and give my consent to participate and be photographed / videod for promotional purposes. I also consent for contact bewteen Dance Integrated Australia and The Farm staff and volunteers to take place.
I understand that any bullying, failing to co-operate with the collaborators and artistic process and any other inapproriate behavior deemed to have a negative impact on my or other particpant’s health & well being, and the reputation of The Corner Dance Lab program, Dance Integrated Australia reserve the right to terminate my residency at my own expense.
IX. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct at the time of completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:
Please upload a headshot

Upload a File

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E-mail
E-mail
Should be Empty:

I. Contact details:

II. Dance Experience:

III. Availability and Interest:

IV. Dance Practice:

V. Acceess Requirements:

VI. Financial Investment

VII. Additional information

VIII. Authorisation and Consent

IX. Applicant's E-Signature