Application Form
The information you provide in this form will be used only for purposes of
admission to Intercultural Theatre Institute (ITI) and will be treated
confidentially.
Application for 2016 / 2017 / 2018 intake (circle appropriate).
1. Particulars of Applicant
Name (underline surname):
Photo
Name in native script (where applicable):
Address where you can be easily reached:
Contact number (include country code):
(
)
(mobile)
(
)
(home)
Email:
Local Identity number / Passport number:
(cicle where applicable)
Date of Birth:
Gender: F / M
Place of Birth:
Nationality (please tick):
⃝ Singapore Citizen
⃝ Permanent Resident
⃝ Others (please specify):
Ethnicity:
Religion:
Marital Status:
2. Education
a. Highest formal educational qualification:
Intercultural Theatre Institure Ltd, Emily Hill, 11 Upper Wilkie Road, Singapore 228120, Republic of Singapore
www.iti.edu.sg T +65 6338 5133 E [email protected]
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b. English Language proficiency
Academic or or other formal qualification
e.g. GCE 'O levels or high school equivalent, IELTS, etc.
(please indicate grade and/or Pass / Fail)
* include a copy of the corresponding certificate or result transcript in Appendix C
Written English:
Spoken English:
Fluent / Adequate / Need help
Fluent / Adequate / Need help
c. Other language proficiencies
(circle appropriate level):
Written: Fluent / Adequate / Need help
Spoken: Fluent / Adequate / Need help
Written: Fluent / Adequate / Need help
Spoken: Fluent / Adequate / Need help
Written: Fluent / Adequate / Need help
Spoken: Fluent / Adequate / Need help
Written: Fluent / Adequate / Need help
Spoken: Fluent / Adequate / Need help
Written: Fluent / Adequate / Need help
Spoken: Fluent / Adequate / Need help
d. Previous theatre training (if you need more space please attach a separate document)
Nature of training/qualification
Technical Theatre experience
Stage Management
⃝ No experience
⃝ Beginner
⃝ Advanced
⃝ Very experienced
Year/Duration
Name of teacher/school
Stage Lighting
Stage Sound
⃝ No experience
⃝ Beginner
⃝ Advanced
⃝ Very experienced
⃝ No experience
⃝ Beginner
⃝ Advanced
⃝ Very experienced
3. Financial Support
If you are offered a place, please indicate how you intend to support yourself:
1. Fee (Bursary/Scholarship, private funding, others - please state)
2. Maintenance (Bursary/Scholarship, private funding, others - please state)
Intercultural Theatre Institure Ltd, Emily Hill, 11 Upper Wilkie Road, Singapore 228120, Republic of Singapore
www.iti.edu.sg T +65 6338 5133 E [email protected]
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4. Health History
YES
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If yes, please explain:
Difficulty with physical exercise
Advice from a physician not to exercise
Muscle, joint or spinal disorder that could be aggravated
by exercise
History of heart problems
History of lung problems
High or low blood pressure
Chronic illness
Recent surgery (within the past 6 months)
Diabetes
Glaucoma
Are you pregnant
Presently taking any medication, which may affect, or be
affected by physical activity
Gout
Epilepsy
Breathing difficulties or asthma
Hernia
Have you been hospitalised recently
Present / recent infections or infectious diseases
(describe)
Please give a brief description of any past or current injuries, structural alignment problems or medical conditions not specified
above.
Are you currently receiving care through any of the following?
YES
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2
3
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If yes, please explain:
Physical Therapy
Psychotherapy
Chiropractor
Others (please state)
5. Personal History
YES
Have you ever been convicted in a court of law in any country?
Have you ever been prohibited from entering Singapore?
Have you ever been refused entry into or deported from any country?
Have you ever entered Singapore using a different passport or name?
If any the answer is "YES", please furnish details on a separate sheet of paper.
6. Appendixes
Please tick if
submitted
Appendix A
Two letters of reference (preferably from arts practitioners/companies)
Appendix B
Experience in the arts
Appendix C
Previous learning experiences (Academic and others)
(Please include all corresponding certificates/result transcripts.)
Appendix D
Employment experience
Appendix E
Statement of aspiration
(tell us why you are interested in joining the programme)
Appendix F
Other things you wish to tell us (Optional)
Intercultural Theatre Institure Ltd, Emily Hill, 11 Upper Wilkie Road, Singapore 228120, Republic of Singapore
www.iti.edu.sg T +65 6338 5133 E [email protected]
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7. Declaration by Applicant
I declare that all the particulars furnished by me in this application are true.
Signature of applicant
Date
Please send the form, along with 2 recent passport size photographs and all appendixes via:
1. Mail:
Attn: Curriculum Coordinator
Intercultural Theatre Institute
11 Upper Wilkie Road
Singapore 228120
OR
2. Email:
Scan and send the completed application form to [email protected]. Please retain the original for
future submission.
Application will be processed upon receipt of the application fee (non-refundable): $32.10 (Singapore dollars).
Fee payable by any of the following methods:
Local Payment
1. Cheque in SGD
Cheques should be made payable to
"Intercultural Theatre Institute Ltd".
2. Cash
Payment may be made at the ITI Administration Office
Overseas Payment
1. Telegraphic Transfer (T/T)
T/T should be made payable to "Intercultural
Theatre Institute Ltd".
All bank charges are to be borne by the applicant.
3. Bank Transfer
ITI’s bank account payment information is:
Bank: United Overseas Bank
Bank No: 7375
Branch: Rochor Branch No: 047
Branch Address: 149 Rochor Road #01-26, Fu Lu Shou Complex, Singapore 188425
Bank Account Name: Intercultural Theatre Institute Ltd
Bank Account No: 354-302-123-5
SWIFT Code: UOVBSGSG
How did you hear about ITI?
¡ Collaterals (brochures, flyers, posters, etc.)
¡ Social Media
¡ Newspaper / magazine (Which? ________________)
¡ Word-of-mouth (Who? ___________________)
¡ Online features / listings
¡ Other: ___________________
For official use only
Reference No:
Date Received:
Receipt No:
Received by:
Requires English Proficiency Test: Yes / No
Director's Signature:
Intercultural Theatre Institure Ltd, Emily Hill, 11 Upper Wilkie Road, Singapore 228120, Republic of Singapore
www.iti.edu.sg T +65 6338 5133 E [email protected]
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