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STEP UP 2015 APPLICATION FORMPlease send completed form (with
video link, applicants will NOT beconsidered without this)to
[email protected] 5pm on Friday16thJanuary 215. !hank
"ou.
Name ofApplicant
Address (forcorrespondence)
Home address(if dierentfrom above).Email
Mobile
Date of birth
Do you have anymedia! ondi"ion
o# addi"iona!need$%
I& you havean$'e#ed ye$ "oa(ove) 'ha"addi"iona!$u**o#")
i& any)
'ou!d you needom u$%
Previous Education and Trainin Histor! (in an!ph!sical
discipline or performin art). #dd e$tra rows
Please insertheadshot%passport
photo here
mailto:[email protected]:[email protected]
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if necessary.
"ourse #$uali%cation
Name ofcollee&institution
Datesattended
'elevant Emplo!ment Histor! i.e 'esume of an!obs or roles in the
performin arts or sportssectors. #dd e$tra rows if necessary.
*ob title&role Emplo!er&Production Dates
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Please use this space to tell us +h! !ou thin, !ou+ould ma,e a
suitable candidate for this -tep ptrainin proram and ho+ !ou +ould
ma,e use ofthe s,ills learnt on the course.&ma$ 2 words. 'f you
would rather not write( you may record spokentestimony instead( and
send as a link or attachment)
Please insert a /ou tube or 0imeo lin, here of a video of !ou
performin in!our stronest ph!sical discipline to ive us an idea of
!our s,ill level. 1t
doesn2t need to be a sho+ reel and can simpl! be footae that is
%lmed on aphone. TH1- 1- AN APP31"AT14N 'E51'EMENT.
'eferee. Please ive the details of a previous emplo!er ortrainer
+ho has a ood ,no+lede of !ou and !our +or, . 6e +illonl! contact
this person if !ou are shortlisted.
Name andposition&title of
'eferee
"ontact details7Email and
Telephone.
Number of!ears 'eferee
has ,no+n !ou.
Declaration71 con%rm that the information iven on this form is
true8 completeand accurate.
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-inature&Name99999999999999999999999999999 Date
9999999999999999999
E$ualit! and Diversit! formThe information !ou ive in this
section is used for statistical andmonitorin processes onl! and
does not form an! part of theselection or admissions process.
Ho+ did !ou learn of the Proram: U*$'in+ e,-ye# U*$'in+ 'e($i"e
A#"$.o($ITC 'e($i"e /o#d o& mou"h A#"$ Couni!
O"he# *!ea$e $*ei&y99999999999999999999999
Personal Details
Date of ;irth 999999999999999999999999999 P#e&e# no" "o
an$'e#
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Note: !he *isability *iscrimination #ct 1++5 de,nes a disability
as a physical or mental impairment which has a substantial andlong
term &i.e. lasting more than 12 months) ad-erse eect on your
day to day li-ing. "ou may still be considered to ha-e a
disabilityif you are not currently ad-ersely aected but the
impairment is likely to recur( or the condition is progressi-e.
Do !ou have dependants: Dependants miht include children8 the
elderl!8 or other people +ho rel! on!ou for care.
6ES NO P#e&e# no" "o an$'e#
