Fellowship Application Form Fellowship Application Form 2019 Please refer to the Guidelines before completing the following application form. 1 Personal Details2 Career History3 Budget/Timeline4 Development Proposal5 Supporting Documents6 Preview Personal DetailsName* First Last Email* Enter Email Confirm Email Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Mobile*Are you of Aboriginal or Torres Strait Islander heritage?*NoYes, AboriginalYes, Torres Strait IslanderYes, both Aboriginal and Torres Strait IslanderWebsite (if applicable) Career HistoryJob Title*Company*Sector*(Select all that apply) Exhibition Distribution Writer Director Producer Production, other Post-production Broadcasting Government Agency Education / Training Other If other, what sector?Within this sector, what field?How many years have you worked in the screen industry?*Short bio (up to 200 words)* Budget and TimelineTotal cost of project*Amount being requested from Natalie Miller Fellowship*Please enter a number less than or equal to 20000.Personal financial contribution to the project*Amount being requested from other funding bodies*Requests to other funding bodies (if applicable)Funding bodyAmountStatus Proposed Start Date Date Format: DD slash MM slash YYYY Proposed Completion Date Date Format: DD slash MM slash YYYY You are required to upload a detailed budget and timeline for your development proposal in the supporting documents section. Development Proposal DetailsProposal Summary*Provide a brief outline (100 – 150 words) of your professional development proposal Note: this may be used for promotional purposesProposal Description*A succinct description of your proposal (300-500 words) including evidence of your ability to execute the project. Drop files here or Proposal Outcomes*Detailed outline (500-800 words) of how the Natalie Miller Fellowship would contribute to your personal development and how it would benefit the wider screen community. Drop files here or Supporting DocumentsResume / CV*Please upload your current Resume/CV including details of business/creative output, education and employment history Drop files here or Proposed budget and timeline*Upload a detailed budget and timeline for your proposal. Drop files here or Confirmation Letter (if relevant)Please include confirmation of acceptance into a professional opportunity e.g. mentor or internship Drop files here or Reference Letters*Include a minimum of 2 signed letters of reference supporting your proposal Drop files here or Any additional supporting documents Drop files here or Preview Your SubmissionPlease use the 'Previous' and 'Next' buttons to make any changes if required.{all_fields}