Digital Extension Production Fund
Application Summary Form
Before completing this form please read the appropriate program guidelines in conjunction with the
ScreenWest Terms of Trade.
[INSERT
DATE]
SCREENWEST
FUNDING REQUEST $
Project /
Activity
Name
TOTAL PROJECT BUDGET $
Does this project have additional finance in place? (If
so, please include evidence of any and all additional
funding for the project)
Has the project/activity
ever been known by
another name (AKA)?
Applicant’s role on the project
One line
synopsis
Estimated starting date
1.0
Est. completion date
APPLICANT DETAILS
APPLICANT /
APPLICANT COMPANY
ABN
Year Incorporated
Registered Business Address
State
Post Code
State
Post Code
Phone
Mob
Applicant Contact Name
Address (if different)
Email
Website
PO Box 8349, Perth Business Centre, Western Australia 6849
Gordon Stephenson House, 140 William Street, Perth Western Australia 6000
Tel: +61 8 6552 7700 Toll Free: 1800 463 043 Fax: +61 8 6552 7777
Email: info@screenwest.wa.gov.au www.screenwest.wa.gov.au
Page 1 of 3
2.0
STATISTICAL INFORMATION FOR THIS APPLICATION
Is the applicant between
15-24
Is the applicant male or female
Male
25-45
46+
Female
Is the applicant company based in Western Australia?
Yes
No
Is the applicant a Western Australian Resident as defined in the Terms of
Trade?
Yes
No
Will there be any Indigenous content involved in this application’s activities/
project/s?
Yes
No
Will there be any Indigenous people involved in this application’s activities/
project/s?
Yes
No
Does this project/activity take
place in regional WA?
3.0
Yes
No
What location
does it take
place?
APPLICANT WARRANTY
In submitting this application, the applicant warrants that they:
1. Have a Western Australian Digital Producer attached to the project. (For this initiative
ScreenWest will accept applications from non-Western Australian Production Companies
where a Western Australian Digital Producer is attached to the project);
2. Have read and understand ScreenWest's current guidelines and Terms of Trade, and
acknowledge that ScreenWest reserves the right to vary any of its terms and conditions
without notice;
3. Will always act in good faith in all dealings with ScreenWest;
4. Have the capacity and resources to carry out the proposal listed above; and
5. Have the right to carry out the proposal (including relevant copyright and clearances).
Signed
[ELECTRONIC NAME/ SIGNATURE IS ACCEPTABLE]
Title
4.0
Date
COPYRIGHT, OWNERSHIP AND CLEARANCES
The applicant producer must hold the rights necessary to produce and exploit the project. If the application is
successful, relevant Chain of Title documents must be provided as part of the contracting process.
Is the work wholly your (the applicant producer’s) original work?
Yes
No
Is the current work based on underlying work? i.e. a book adaptation
Name of underlying work (book) if applicable
Yes
No
Is the project partly or wholly based on a real life person or event?
If yes, please provide details
Yes
No
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Digital Extension Production Fund – Application Summary Form – Last updated April / 2014
Do you (the applicant producer) currently hold the rights to make the project?
Yes
No
If you DO NOT hold all the rights necessary to produce the project
 Who is the current rights owner of the work?

Describe the rights you need and how do you intend to secure these
rights
INDIGENOUS CONTENT AND PARTICIPATION (if relevant)
If the project involves Indigenous content or participation including using Indigenous land, as
locations, communities or there is an Indigenous character there are particular requirements for
consultation and content involved. Please see Pathways & Protocols: a filmmaker’s guidelines to
working with Indigenous people, culture and concepts on the Screen Australia website.
Does your project have Indigenous content, or require participation from Indigenous peoples?
Yes
No
Describe the role Indigenous participation or content plays in the project
Describe your Indigenous consultation plan
CHECKLIST OF SUBMISSION MATERIALS FOR DIGITAL EXTENSION PRODUCTION FUNDING
A cover letter listing all submission materials submitted
A completed application summary form
Script(s) or Treatment, and one paragraph synopsis of the Primary Project
Script(s) or a detailed Outline or Treatment of the Digital Extension’s creative content
A producer’s statement detailing the creative vision and objectives of the Digital Extension,
and how it extends from or builds on the Primary Project
Functionality and/or interactivity overview, including details on how the narrative unfolds
across the alternate platform(s) and the user-experience
Wireframes and/or prototyping
Market overview, including details of the target audience, strategies for obtaining audience
traction, and key performance indicators (KPI’s)
Detailed budget with the digital spend clearly identified, and any components already
accounted for as part of the Primary Project’s production budget (e.g. research, rushes to be
utilised in the Digital Extension, archival rights already cleared for digital distribution, etc.)
Finance plan for the Digital Extension, including evidence of other finance sources
A clear summary of the Digital Extension’s delivery materials
Evidence of the Primary Project being fully-financed, including evidence of the broadcaster
or distribution entity attached to the Primary Project
One page CV’s of the key creatives of both the Digital Extension and the Primary Project
Any additional relevant supporting creative materials
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Digital Extension Production Fund – Application Summary Form – Last updated April / 2014