! ! ! ! ! !! !! ! Audition Application Form ! ☐ ☐ Diploma in Theatre Performance (3 years) Diploma in Teaching Studies (2/3 years) ! Please affix passport sized photograph. Tick as appropriate Please complete in BLOCK CAPITALS. If any question requires extra space, please attach additional pages to this Application Form. Surname: First Names: Date of Birth: Permanent Address: (inc. post code) ! ! ! Tel Nos. Home: Mobile: Email: Full name of Parents/Guardians: Address and telephone number: (if different from above) ! ! Fathers occupation: Mothers occupation: Full Name(s) and Address(es) of academic schools attended from age 11. ! ! Please list below all academic qualifications past or planned. Date Name of examination Subject Grade Date (G.C.S.E., A-Level etc) Name of examination Subject Grade Subject Level (G.C.S.E., A-Level etc) Full name of current dancing/performing arts school/college: !! !! ! Address and telephone number: Name of dance/performing arts teachers: Please detail below all dance/performing arts training that you have undertaken. Date Examining Body e.g. I.S.T.D., R.A.D. Subject Level Date Examining Body e.g. I.S.T.D., R.A.D. Page 1! of 2 Please give details of any special skills, musical instruments played, vocal/choral experience or previous performing experience: !! !! ! ! As a CDET accredited college The Centre PAC is required to record details of all applicants in the interest of widening access and participation in the performing arts: Please tick the box to describe your ethnic origins. (This information is for monitoring purposes only and does not affect our audition process). ☐ ☐ ☐ White UK White European White other ☐ ☐ ☐ ☐ Black UK Black Caribbean Black African Black other ☐ ☐ ☐ ☐ Asian - Indian Asian - Pakistani Asian - Japanese Asian - other ☐ ☐ ☐ ☐ Mixed - White/Black Caribbean Mixed - White/Black African Mixed - White/Asian Mixed - other Health/Disability - Please tick any box which best describes you. (This information is for monitoring purposes only and does not affect our audition process). ☐ ☐ ☐ ☐ No known disability Learning disability Dyslexia/dyspraxia ☐ ☐ ☐ Visual impairment Hearing impairment Mobility issues ☐ ☐ ☐ Eating disorder e.g. anorexia/bulimia Medical condition e.g. Asperger’s, epilepsy Unseen disabilities e.g. diabetes, asthma Mental health issues If your application is successful The Centre PAC will require a full medical report from your doctor before registration. Please attach your personal statement detailing why you have chosen The Centre PAC and what you hope to achieve after completing your chosen course. ! ! How did you hear about The Centre PAC? How do you intend to fund the course at The Centre PAC? I confirm that to the best of my knowledge the information given on this application form is correct and complete. !! ! Signature of applicant: Date: Signature of Parent/Guardian: Date: ! Please tick to make sure that you have included the following: ! ! ☐ Non-refundable audition fee of £40.00 (Cheques made payable to ’The Centre’) ☐ One passport sized photograph attached to the front of this application form. ☐ One full length photograph in dancewear, with your name on the back. ☐ One written reference from your current academic school or college. ☐ One written reference from your current dance/performing arts teacher. ☐ Completed personal statement detailing your course objectives and future ambitions. ☐ Signatures of applicant and parent or guardian on the declaration above. Please notify The Centre PAC should there be any change in the information given. Please return to: The Centre - Performing Arts College, Rochester Dance Junction 681, Maidstone Road, Rochester Kent. ME1 3QJ !! Page 2! of 2