1. hobbies and interests
2. guitar

QkeZ uForm No.
jk"Vªh; ukV~; fo|ky;
NATIONAL SCHOOL OF DRAMA
Bahawalpur House, Bhagwandas Road, New Delhi 110 001
Telephones: (+91-11) 23389402, 23387916
www.nsd.gov.in
vkosnu i= 2015
APPLICATION FORM 2015
Please affix a
passport-size colour
photograph here,
and attach 3
additional
photographs to the
application form
bl vkosnu i= ds t+fj, gh p;u lfefr Ikj vkidk igyk izHkko iM+xs kA blfy, Ñi;k bls lkQ&lkQ HkjsaA Vafdr gks rks vPNk
gSA laf{kIr tkudkjh nas c<+k&p<+kdj u fy[ksaA fdlh Hkh rjg ds v/kwjs vkosnu i= Ikj fopkj ugha fd;k tk,xkA
A.
Name in full (in capital letters) Shri/Shrimati/Kumari ______________________________________________
Ikwjk uke ¼Li"V v{kjksa es½a Jh@Jherh@dqekjh_____________________________________
Date of birth ___/____/________Age as on 1/7/2015________years________months_____ days
tUe frfFk
Nationality/
1@7@2015 dks vk;q
lky
ukxfjdrk _________________
Male
eghuk
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fnu
Female/ L=h
Present address (in capital letters)_________________________ City__________
OkrZeku irk
'kgj
District____________ State _______________Pin__________Phone no.______________
ftyk
jkT;
fiu
Qksu
Permanent address (in capital letters)_________________________ City__________
LFkkbZ irk
'kgj
District____________ State _______________Pin__________ Phone no._______________
ftyk
jkT;
fiu
Qksu
Mother’s name ___________________________ Father’s name_______________________
Ekkrk dk uke
firk dk uke
Address )_______________________________________________ City__________
irk
'kgj
District____________ State _______________Pin__________ Phone no.________________
ftyk
jkT;
fiu
Qksu
E-mail ______________________________________________
(Kindly provide your e-mail address for speedy communication)
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Father’s/mother’s profession, and his/her annual income______________________________
firk@ekrk dk O;olk; vkSj mudh okf"kZd vk;
Whether SC/ST/OBC (attach documentary proof, duly verified)___________________________
D;k vuqlwfpr tkfr@tutkfr@vU; fiNM+k oxZ ls gSa ¼;fn gkW rks lR;kfir izek.k i= layXu dhft,½
Married/Unmarried__________________________________________________________________
fookfgr@vfookfgr
If married, husband’s/wife’s name and address__________________________________________
;fn fookfgr gSa rks Ikfr@iRuh dk uke o Ikrk ____________________________________________
____________________________________________________________ City__________
'kgj
District____________ State ___________ Pin__________ Phone no.______________________
ftyk
jkT;
fiu
Qksu
Husband’s/wife’s profession and his/her annual income__________________________________
ifr@iRuh dk O;olk; ,oa mldk@mldh okf"kZd vk;
Number of children, if any_____________________Contact phone no.______________________
laidZ gsrq ua-] ;fn gks
CkPpksa dh la[;k] ;fn gSa
B.
KNOWLEDGE OF LANGUAGES
Can speak fluently
Ckksy ldrs gSa
Hkk"kkvksa dk Kku
Can read fluently
Can write fluently
___________________
_______________________
i<+ ldrs gSa
______________________
fy[k ldrs gSa
______________________
___________________
______________________
______________________
___________________
______________________
'kSf{kd ;ksX;rk
(Attach attested copies. lR;kfir izfrfyfi layXu djsa½
ACADEMIC QUALIFICATIONS
Certificate/Degree/Scheme Year
izek.k&i=k@[email protected]
High School
o"kZ
University/Board/Institute
fo'ofo|ky;@cksM@
Z laLFkku
Marks obtained (%)
izkIr vad
_____
____________________
_________
_____
____________________
_________
______
_______________________
___________
Main subjects
eq[; fo"k;
___________
gkbZLdwy
Intermediate
___________
baVjehfM,V
Graduation
______________
Lukrd
Postgraduation
_______
_______________________
___________
______
____________________
_________
_____________
LukRdksÙkj
Training, if any
____________
dksbZ vU; izf'k{k.k
2
THEATRE EXPERIENCE
Direction
jaxeap vuqHko
funsZ'ku
Mention any 6 major productions the applicant has directed. (Attach separate sheets for more productions.)
vH;FkhZ }kjk funsfZ 'kr fdUgha 6 ukV~;&izLrqfr;ksa dk mYys[k djsAa ¼vf/d izLrqfr;ksa ds fy, vyx ls dkxt+ layXu djsAa ½
Name of play
Language
Place/Occasion
UkkVd dk uke
Hkk"kk
LFkku@lekjksg
____________
____________
____________
____________
____________
____________
________
________
________
________
________
________
____________
____________
____________
____________
____________
____________
Author/Playwright
Year
ys[kd
o"kZ
________________
________________
________________
________________
________________
________________
_________
_________
_________
_________
_________
_________
Acting vfHku;
Mention any 6 major roles the applicant has performed.
vH;FkhZ }kjk vfHkuhr vf/kdre 6 izeq[k ukV~; Hkwfedk,aA
Name of play
Language
Author/Playwright
Directed by
Role
UkkVd dk uke
Hkk"kk
ys[kd
funZs'kd
Hkwfedk
____________
____________
____________
____________
____________
____________
________
________
________
________
________
________
____________
____________
____________
____________
____________
____________
___________
___________
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___________
___________
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____________
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Stage Craft eap f'kYi
Mention any 6 major productions in which the applicant was actively involved in stage design, set construction, lighting,
costume design, make-up, stage management, etc.
fdUgha 6 izeq[k izLrqfr;ksa esa vH;FkhZ }kjk fd;s x, eap ifjdYiuk] eap&fuekZ.k] izdk'k] os'k&Hkw"kk vfHkdYiuk] :i&lTtk] eap izca/ ku bR;kfn
dk;ksaZ dk mYys[k djsaA
Name of play
Author/Playwright
UkkVd dk uke
___________
___________
___________
___________
____________
____________
ys[kd
dk;Z dk izdkj
o"kZ
____________
____________
____________
____________
____________
____________
dk;Z
Language
UkkVd dk uke
______________
______________
______________
Year
____________
____________________
____________
____________________
____________
____________________
____________
____________________
________
____________
___________
________
____________
___________
WRITING SKILLS ys[ku
Plays UkkVd
Name of play
Nature of Work
Hkk"kk
_________
_________
_________
Attach separate sheet if needed.
Full-length/One-act
UkkVd@,dkadh
_______________
_______________
_______________
Staged/Not staged
iznf'kZr@viznf'kZr
_________________
_________________
_________________
vko';d gksus ij fooj.k vyx dkxt+ ij layXu djas A½
3
Poetry dfork
_______________
_______________
_______________
Stories dgkfu;k¡
Novels miU;kl
________________
________________
________________
OTHER QUALIFICATIONS vU;
_____________________
_____________________
_____________________
;ksX;rk,Wa
Any previous training in theatre? If yes, its nature___________________________________________
jaxeap esa dksbZ iwoZ izf'k{k.k\ ;fn gS] rks fdl izdkj dk gS\
Any previous training in dance, music (vocal/instrumental), visual art?__________________________
Uk`R;] laxhr ¼xk;u@oknu½ ,oa n`';dyk esa dksbZ iwoZ izf'k{k.k \
Any other qualifications______________________________________________________________
dksbZ vU; ;ksX;rk,a
ORGANISATIONS ASSOCIATED WITH laLFkku ftlls lac) gSa
Name of the organisation
Professional/Amateur
Since when
In what capacity
laLFkk dk uke
O;kolkf;d@'kkSfd;k
dc ls
fdl :Ik esa lEc) gSa
_________________
_________________
_________________
__________________
__________________
__________________
__________
__________
__________
______________
______________
______________
C.
PROFESSIONAL BACKGROUND O;kolkf;d Ik`"BHkwfe
Present occupation________________________________Annual income_________________________
orZeku O;olk;
okf"kZd vk;
Experience of other jobs, if any_____________________________________________________________
vU; dk;ksZa dk vuqHko] ;fn gS
Whether recipient of any scholarship while undergoing training, etc.__________________________
vxj izf'k{k.k bR;kfn ds nkSjku fdlh Hkh izdkj dh Nk=o`fr izkIr dh gS rks mYys[k djas
If recipient of any scholarship, mention:
;fn Nk=o`fr izkIr dh gS rks
(i) Amount of monthly scholarship_____________________________________________________
ekfld Nk=o`fr dh jkf'k
(ii) Scholarship received from which date________________________________________________
Nk=o`fr dc ls izkIr dj jgs gSa
(iii) Source of scholarship___________________________________________________________
Nk=o`fr dk lzksr
D.
PREVIOUS ATTEMPTS fiNys iz;kl
Have you applied to this course previously? How many times? (Mention year/s.)
IkwoZ esa fdruh ckj vkosnu fd;k \ ¼o"kZ dk mYys[k djsa½
Preliminary interview _______________________ Final interview/Workshop________________________
IkzkjafHkd lk{kkRdkj
vafre lk{kkRdkj@ dk;Z'kkyk
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E.
STATE OF HEALTH LokLF;
(i) Are you physically fit to undertake theatre practice for long hours?___________________________
¼d½ jaxeap ij nsj rd dk;Z djus ds fy, D;k vki 'kkjhfjd :i ls LoLFk gSa \
(ii) Have you undergone any training in physical fitness? If yes, mention details.________________________
¼[k½ D;k vkius 'kkjhfjd LoLFkrk gsrq dHkh dksbZ izf'k{k.k fy;k gS\ ;fn gk¡] rks mYys[k djsa A
(iii) Your height and weight____________________________________________________
¼x½ viuk otu vkSj mQ¡pkbZ dk C;kSjk nsaA
F.
REFERENCES vkosnd ds tkudkj
At least 3 eminent persons in the theatre field, not related to the applicant but familiar with his/her work, should be
mentioned, and certificates given by them should be attached with this application.
jaxeap {ks= ds de&ls&de rhu izfl) O;fDr;ksa ds uke] tks fd vkosnd ds laca/kh u gksa ysfdu muds dk;Z dh iw.kZ tkudkjh j[krs gks]a nsa A
muds }kjk fn;s x, izek.k i= Hkh layXu djas A
Name
Ukke
_________________
_________________
_________________
Address
Status
irk
Lrj
________________________
________________________
________________________
__________________
__________________
__________________
GENERAL/
Plans after training_________________________________________________________________
Ikzf'k{k.kksijkUr ;kstuk
Any other information______________________________________________________________
dksbZ vU; lwpuk
I have read the rules of the National School of Drama and agree to abide by them.
EkSaus jk"Vªh; ukV~; fo|ky; esa izos'k ds fu;e i<+ fy, gSa vkSj mudk ikyu djus ds fy, opuc} gw¡A
I have already sent/deposited DD No.__________for Rs 225 (inclusive of Rs 75 as postage expenses)
dated___________issued by _________________________ (bank’s name) for the prospectus and application
form.
eSa foojf.kdk o vkosnu i= gsrq :- 225@& ¼:- 75@& ds Mkd 'kqYd lfgr½ fMekaM Mªk¶V
la[;k&&&&&&&&&&&&&&&&&&&&fnukad&&&&&&&&&&&&&&&&&tkjh&&&&&&&&&&
¼ukekafdr cSad½ igys gh Hkst@tek dj pqdk gw¡ A
fo|ky; }kjk vius fdlh foHkkx esa f'k{kko`fr@ekuns;@foLrkfjr vuqca/k ds vk/kj ij tks Hkh 'kks/kdk;Z eq>s lkSaik tk,xk] mlds fy, ,d o"kZ
rd fo|ky; dh lsok djus ds baVuZf'ki vuqca/k dks Lohdkj djus ds fy, eSa lger gw¡ vkSj mls iw.kZ djus dk opu nsrk@nsrh gw¡ A
______________________________
______________________________
Date
Signature of Applicant
frfFk
vkosnd ds gLrk{kj
5
FOR OFFICE USE ONLY dsoy dk;kZy; ds iz;ksx gsrq
Interviewed on____________________________________________________________________
lk{kkRdkj dh frfFk
Report of interview_________________________________________________________________
lk{kkRdkj dh fjiksVZ
Admitted/Not Admitted_______________________________________________________________
izos'k iznku fd;k@ugha fd;k x;k
Director funs'kd
INDICATE YOUR FIRST, SECOND & THIRD preference of area of specialization from 2nd year
onwards by writing 1,2 & 3 in the boxes given below.
ÑIk;k viuh ilUn ds ojh;rkuqlkj 1, 2 vkSj 3 fy[kas %
Acting
Direction
Theatre Technique & Design
vfHku;
funs'Z ku
jaxeap rduhd vkSj vfHkdYiuk
CENTRES OF PRELIMINARY INTERVIEW IkzkFkfed lk{kkRdkj ds fy, dsUnz
Indicate your first and second preferences by writing 1 and 2 for any two centres of your choice:
ÑIk;k viuh ilUn ds nks dsUnzksa esa ojh;rkuqlkj 1 vkSj 2 fy[kas %
Delhi
Kolkata
fnYyh
dksydkrk
Mumbai
eqEcbZ
Bengaluru
caSxyq:
Guwahati
xqokgkVh
Lucknow
y[kuÅ
6
CHECK LIST tk¡p lwph
Note: Please tick-mark the square applicable to you and sign in the appropriate space below:
fVIi.kh % tks Hkh vkids fy, vuqiz;ksT; gks] ml oxZ esa lgh dk fu'kku yxk,Wa vkSj uhps mfpr LFkku ij gLrk{kj djsa A
gkWa
ugha
Have you attached attested copies of certificates and degrees of examination passed?
D;k vkius mŸkh.kZ ijh{kkvksa ds izek.k&i=ksa vkSj fMfxz;ksa dh lR;kfir izfr;kW¡ layXu dh gS \
Have you attached an attested copy of the certificate of High School or Matric or equivalent
examination in support of your age?
D;k vkius viuh mez ds leFkZu esa gkbZLdwy ;k eSfVªd ;k led{k ijh{kk ds izek.k&i= dh lR;kfir izfr layXu dh gS\
Have you attached three additional passport-size colour photographs?
D;k vkius ikliksVZ vkdkj ds vius fp= dh rhu vfrfjDr izfr;ka layXu dh gSa \
Have you attached certificates from three eminent persons in the theatre field testifying to
your experience in theatre ?
D;k vkius jaxeap {ks= ds fdUgha rhu izfl} O;fDr;ksa ls izkIr i= layXu fd, gSa tks jaxeap esa vkids vuqHko dks
lR;kfir djrs gksa \
Have you attached documentary proof of your theatre experience?
D;k vkius vius jaxeap vuqHko dk fyf[kr izek.k layXu fd;k gS \
Ñi;k viuk vkosnu i=k layXu fyQkQs esa LihM iksLV }kjk HksatAs
In case of foreign nationals the applicant should apply through the Indian Embassy in his/her country and the Director
General, Indian Council for Culture Relations, Azad Bhawan, New Delhi 110 002.
fons'kh vH;FkhZ vius ns'k ds Hkkjrh; nwrkokl vkSj egkfuns'kd] Hkkjrh; lakLÑfrd ekeys ifj"kn~] vkt+kn Hkou] ubZ fnYyh&110002 ds ekè;e ls vkosnu djsa A
Signature of Applicant/ vkosnd ds gLrk{kj % _____________________
Name of the Applicant______________________________________
vkosnd dk uke %
Contact phone no: ___________________________________________
laidZ Qksu %
7
'kiFk i=
¼vH;FkhZ bls Hkjdj vius gLrk{kj lfgr vkosnu i= ds lkFk tek djsa ½
EkSa] ---------------------------------------------------------------------------------------------lqi=q @lqiq=h-----------------------------------------------------------fuoklh---------------------------------------------------------------------------------------------------------------------------------------------------------------'kiFk ysrk@ysrh gw¡ fd jk"Vªh; ukV~; fo|ky; ds fMIyksek ikB~;Øe esa izo's k gksus ij esjk O;Okgkj iw.kZRk;k 'kksHkuh;
jgsxk vkSj fo'okl fnykrk@fnykrh gw¡ fd eSa bl nkSjku fdlh Hkh rjg dh jSfxax xfrfof/k esa fgLlk ugha
ywxa k@yaxw hA ;fn vf/dkjh eq>s bl laca/k esa fo|ky; }kjk tkjh funsZ'kksa dk mYya?ku djrk gqvk ikrs gaS] rks fo|ky;
dks fu/kkZfjr dkuwuh dkjZokbZ djus dk vf/kdkj gksxkA fo|ky; us eq>s ekuuh; loksZPp U;k;ky; ds vè;kns'k
W.P. (c) laLFkk
fnukad 4-5-2001 ds lacaf/kr va'k ls voxr djk fn;k gS] vkSj ;g 'kiFk i=
mijksDr vkns'k ds rgr izLrqr fd;k tk jgk gS A
Nk=k@Nk=k dk uke o gLrk{kj
irk
Undertaking
(To be filled in by the applicant and submitted along with the application, duly signed)
I, _______________________________________son/daughter of_____________________
resident of____________________________________________________________________,
hereby undertake that in the event of my selection to the Diploma course in the National School
of Drama, I hereby vouch for my good conduct and assure that I will not indulge in any kind of
ragging. In case the authorities find me violating the instructions issued by the School in this
regard, apart from the criminal legal action which will be initiated as per law, the School
authorities will also be at liberty to take appropriate action against me as provided in the
instructions. The School has also made me understand the relevant portion of the order of the
Supreme Court of India in W.P.(C) No. 656/1998 dated 04.05.2001 and this undertaking is being
given pursuant to the above order.
Name and Signature of Student______________________________________
Address_______________________________________________________
_______________________________________________________________
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