Amplify Member Application Form 2019

Amplify Application Form

Please fill in the form below.
The questions below help us get a sense of who you are as an artist. The starred questions are essential for putting you on our system. The others are optional but useful for us!

To be eligible for Amplify you must come from or currently live in the East Midlands.
Contact Details
Full Name *

Prefix First Name Last Name
Current Address *

Street Address

Street Address Line 2

Town/City County

Post Code Country
Phone Number *

Area Code Phone Number
E-mail *
Website
Instagram
@username
Twitter Handle
@username
Education history
Primary School *

School

Address Line 1

Local area City/Town
Secondary School *

School

Address Line 1

Local area City/Town
6th Form / College

School

Address Line 1

Local area City/Town
Higher Education

School

Address Line 1

City/Town Area/County
Qualifications
Any other relevant training
Eligibility for Amplify
What’s your connection to the East Midlands? If you currently live elsewhere, where did you grow up? *

0/40
What type of artist are you? (tick all that apply) *

Director Producer Writer Actor/Performer Theatre-Maker Workshop Leader/Practitioner/Facilitator Dramaturg Set Designer Sound Designer Costume Designer Lighting Designer Choreographer Movement Director AV Designer Composer Puppet Director Puppet Designer Video Designer
If you are part of a company or collective, please list them here
If you are a member of any unions or professional bodies, please list them here
Amplify projects you have applied for or attended so far *

Amp Night Ideas Submissions Plug-In Amplify Festival Workshops JMK Workshop £10 tickets Booked space in the building Residency Creative Associates Invited us to see your work Talawa MAKE Open Door A one-to-one meeting with Nottingham Playhouse staff None
Tell us briefly about your creative practice (can be a couple of sentences!)

(Max 2 paragraphs) 0/120
Give us a brief overview of your career so far and where you'd like to progress to.

(Max 2 paragraphs) 0/120
What would you like to get out of Amplify? Answer as an individual, or on behalf of your company/collective

(Max 1 paragraph) 0/80
Attach your CV - this can be an individual or company CV

Browse Files
You can upload multiple files Cancel of
Or add your Spotlight Link / online CV
Contact Preferences

As an Amplify member, you will automatically be signed up to receive communications specific to the programme. You may also sign up to receive additional relevant communications from third parties, or to have your information shared with relevant industry professionals.
Please tell me about relevant offers and opportunities, shows, ticket offers, workshops, events, news and other activities from selected theatres, theatre companies, artist development schemes and Amplify members (e.g offers from In Good Company, Paines Plough and Talawa). *

By Email By Post By Phone
I am happy for my name, mobile number and email address to be passed on to an industry professional for a specific professional or artist development opportunity (e.g. sharing your details with professionals looking for producers, actors etc). *

Yes No
Equal Opportunities
EQUAL OPPORTUNITIES

Nottingham Playhouse Trust Limited is committed to a policy of equality of opportunity for developing artists through Amplify. In particular, the Company aims to ensure that no potential or actual employee, freelancer, workshop participant or any other visitor receives more or less favourable treatment on the grounds of, for example, race, colour, ethnic or national origins, marital status, sex, sexual orientation, age, disability or religious beliefs.

We wish to build an accurate picture of the diversity of our users which will help us to monitor our policy and assist in its development. It is also a requirement to report diversity statistics to our funders who want to better show the diversity, both visible and invisible, of the workforce of the sector and is in line with best practice guidance. The monitoring characteristics used are as defined by the Office for National Statistics.

We would be grateful if you would complete the following information. The answers will be used solely for monitoring purposes and no one individual can ever be identified.
GENDER
Do you identify as:

Male Female Non-Binary Prefer not to Say
AGE
Under 16 16-19 20-34 35-49 50-64 65+ Prefer not to say
ETHNIC ORIGIN
How would you describe your ethnic origin?

White British White Irish White Gypsy or Irish Traveller Any Other White Background Asian Bangladeshi Asian Indian Asian Pakistani Any Other Asian Background Black African Black Caribbean Any Other Black Background Chinese Arab Dual Heritage: Asian and White Dual Heritage: Black African and White Dual Heritage: Black Caribbean and White Dual Heritage: Chinese and White Any Other Mixed or Multiple Ethnic Background Any Other Ethnic Group Prefer Not to Say
DISABILITY
Do you consider that you have a disability?

No Visual Impairment Hearing Impairment / Deaf Physical Disability Cognitive or Learning Disability Mental Health Condition Invisible Disabiity Other Long Term / Chronic Condition Prefer Not To Say
If yes please give any additional information which you feel would be relevant:
SEXUAL ORIENTATION
Type a question

Bisexual Gay Man Gay Woman / Lesbian Heterosexual / Straight Prefer Not To Say
CARING RESPONSIBILITIES
Do you have caring responsibilities? If yes please select all that apply:

Primary carer of a child / children under 18 Primary carer of a disabled child / children Primary carer of a disabled adult (18 and over) Primary carer of an older person/people (65 and over) Secondary carer None Prefer Not To Say
SOCIO-ECONOMIC BACKGROUND
Currently there are no agreed definitions for 'class' or how to define someone's socio-economic background/context. However we are keen for artists to be able to describe to us how they define themselves if you'd like to.
Should be Empty:

Amplify Application Form

Contact Details

Education history

Eligibility for Amplify

Contact Preferences

Equal Opportunities