Affix passport size

color photograph here

and attach 1 additional
photograph to the
application form

NATIONAL SCHOOL OF DRAMA

Bengaluru Chapter
Guru Nanak Bhavan. No. 6
Tank Bund Road, Vasanthanagara, Bengaluru-560052

ONE YEAR INTENSIVE COURSE IN ACTING

(2014-15)

APPLICATION FORM

Name in full ( ( in block letters ) Shri / Smt./ Km._____________________________________________

Date of Birth ____/___/_____ Age as on 1/8/2014 __________ Years ___________ Months________

days_______ Nationality _________Male ___ Female _____

Present Address ( In Block letter)________________________________________________________

City ____________ Distt._____________ State ___________________ Pin _______ Phone__________

Permanent Address ( In Block Letter)______________________________________________________

City ____________ Distt._____________ State ___________________ Pin _______ Phone__________

Emergency Contact No. _____________________ E -.mail _____________________________________

Mothers’ Name ______________________________ Father’s Name ____________________________

Fathers’ / Mother’s profession and his /her annual income ____________________________________

Whether SC/ ST/ OBC /( attach documentary proof duly verified )_______________________________

Married / unmarried ___________________________ Number of children, if any__________________

Academic Qualification (attach attested copies)

Board / degree Year University / Board/ Institute Main Subject % of Marks obtained

High School ______ _____________________ ___________ __________________

Intermediate ______ _____________________ ___________ __________________

Graduation ______ _____________________ ___________ __________________

Post Graduation ______ _____________________ ___________ __________________

Training, if any ______ _____________________ ___________ __________________

Experience in Theatre (Separate sheet/s can be attached)

Play/s workshop/s Directed by / conducted by Duration Organization Your participation as

_______________ _______________________ __________ _________ __________________

_______________ _______________________ __________ _________ __________________

_______________ _______________________ __________ _________ _______________

______________ _______________________ __________ _________
________________________________ _______________________ __________ _________

Other Qualifications / Experience

Dance , Music ( Vocal/ instrumental ) or Visual Art

_____________________________________________________________________________________
_____________________________________________________________________________________

Purpose of Joining the course is (Give detailed description in 20 lines on a separate sheet)

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 so , mention it _________________
(iii) Mention your height and weight_______________________________________________

I am enclosing herewith DD.No. ___________ of Rs 100/- dated _________________ issued by the

bank _________________( Nationalized bank) favoring NSD, Bengaluru Chapter.

I agree to abide by the rules & regulations of National School of Drama, Bengaluru Chapter and fulfill all
the responsibilities assigned to me .

____________ __________________
Date Singnature of Candidate
Note:-

1. Please send your application in an envelope titled “Application for aforesaid diploma 2014-15 by
Post Or directly submit to the Camp NATINAL SCOOL OF DRAMA, Bengaluru Chapter, Guru
Nanak Bhawann. No. 6 Tank Bund Road, Vasanthanagara, Bengaluru-560052
2. Please attach 2 reference of the theatre personalities recommending your candidature
FOR OFFICE USE ONLY
Interviewed on_______________________________________________________________________
Report of Interview __________________________________________________________________
Admitted /not Admitted_______________________________________________________________

Director
National School of Drama