2016 Intake
Audition Application
Form
Applications Close Friday
7th August 2015
Section A: Personal Details:
Please Attach
Photograph
Here
Name: _______________________________________
Date of Birth: _________________
Postal Address: __________________________________
Home State: ______________
Email Address: _____________________________________
Telephone Number: _____________________________
Mobile Number: ________________________
Emergency Contact Name: ____________________ Emergency Contact Number: _________________
Have you Auditioned for NAISDA before? If so what year(s)? ______________
Have you attended a Connect-Ed/Garabara Ngurra Dance camp? If so what year(s)? ________________
Have you attended any other NAISDA related worskshops? ____________________________________
Section B: Aboriginal and/or Torres Strait Islander Status:
Aboriginal
Torres Strait Islander
 Aboriginal and Torres Strait Islander
Section C: Brief statement about how you found out about NAISDA and why
you would like to study at NAISDA:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
1
Section D: Have you had any previous dance training or experience (Cultural,
Contemporary, Hip Hop etc.)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
______________________________________________________________________
Section E: Past Educational History
List below any studies that you have completed or attempted. You need to include a copy of any
transcripts or certificates.
Years Attended
Institution
Title of the Course
Full Time or
Part Time
Date of completion
Section F: Employment History
Year
Employer
Department or
section
Full time
or Part
Time
2
Nature of Work
Section G: Medical Information
This section MUST be completed by a General Practitioner or Health nurse.
NAISDA Dance College offers only Full Time Courses that can be strenuous on the body. NAISDA collects your medical
information to assess and minimise the risk of serious injury occurring during the course of study. Your medical
information will only be used by the relevant NAISDA staff and will be treated as strictly confidential. Disclosing any
information will not automatically exclude you from entry into this course.
1) Has the applicant suffered from any muscular-skeletal injuries within the past 3 years? Please list and describe
including any treatment undergone.
2) Has the applicant had any minor or major surgeries in the past 3 years? Please list and describe below.
3) Do you believe that the applicant would be able to withstand the physical rigours of a 35hour per week Dance
course for the next 4 years? Please comment below.
4) Is there a history of any of the following? Please explain below.
Eating Disorders
Self Harm
Dependence on Medications
 Anxiety
Allergies
Dependence of Drugs/Alcohol
Depression
Asthma
Cardiovascular Problems
5) Is there any other medical history of the applicant?
Applicant Name: __________________________________________
PRACTITIONER’S
STAMP
Medical Practitioner’s Name: ________________________________
Medical Practitioner’s Signature: _____________________________
Date of Examination: _______________
3
Section H: Applicant Declaration
I declare to the best of my knowledge that the information entered on this form is correct and complete.
I am aware that I may be filmed and/or photographed during the Audition and that these may be used by
NAISDA for Training, Assessment and/or Marketing purposes.
Signature of applicant: _______________________ Date: ___________________
If the applicant is under 18 years of age, please also ask your parent/guardian to sign.
Name of Parent/Guardian: ____________________ Parent/Guardian Signature: _________________
Section I: Reference
Please attach One (1) professional reference from someone who has known you for at least 12 months.
The reference may want to refer to the following questions:
1. How long have they known the applicant and what is their relationship.
2. What are the applicants qualities.
3. Why do they think that the applicant would be suited to pursue a career in dance.
Section J: Checklist
Please ensure you have completed all the information above and provide the following certified
documentation with your application;
1. Section A completed with a recent photo and a copy of proof of identification (passport, birth
certificate of Drivers Licence.)
2. Section B completed with Proof that you are of Aboriginal / Torres Strait Islander decent.
3. Section C and D complete.
4. Section E complete with Copies of Any training undertaking eg. Higher School Certificate, VET
or TAFE.
5. Section F complete is applicable.
6. Section G to be completed by a medical practitioner. A recent photo (taken in the past 6
months)
7. Section H Complete.
8. Section I: reference included.
6. Section J checklist complete.
All documentation should be returned by Friday 7th August 2015 to:
Course Administrator—Elizabeth Bailey
NAISDA Dance College
PO Box 7103
KARIONG NSW 2250
Or e.bailey@naisda.com.au
4