Do It Thissen Cinema

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* 1. First Name

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* 2. Surname

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* 3. Address and contact details

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 4. Where will your film(s) be shown in Bradford District?

City

Manningham

Bradford Moor

Tong

Keighley Central

Keighley West

Other (please specify)

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* 5. If you have a venue, please tell us about it. (350 words max)

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* 6. Describe why there is a need for a social cinema where you live.
How have you identified this? (350 words max)

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* 7. What social issue will your cinema be exploring? How will social cinema make a difference in your community? (350 word max)

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* 8. Who are your intended audience? Please tick all relevant boxes.

Working class
(white and minority ethnic)

Minority backgrounds

Families

At home mums/parents

Traveller community

Young people aged 16-25

Older, aged 65+

Refugee / asylum seeker

Other (please specify)

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* 9. How will you ensure you will attract diverse audiences?

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* 10. Tell us about the types of films you would like to screen.
Explain why you have chosen these.

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* 11. What are the discussions/activities that may develop as a result of having
a social cinema in your local area?

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* 12. What skills/experiences do you hope to learn/develop from your social cinema?

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* 13. How many viewings would you like funding for?

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* 14. What would you spend your support money from The Leap on?

Item of Spending

Cost

Item of Spending

Cost

Item of Spending

Cost

Item of Spending

Cost

Item of Spending

Cost

Item of Spending

Cost

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* 15. Referees: Please provide us with details of two referees who know about your film idea
and would be willing to provide a reference. Please check before naming them.
Family members are not permissible.

Referee 1

Name:

Address:

Job Title:

Telephone Number:

Email address:

Relationship to you:

Referee 2

Name:

Address:

Job Title:

Telephone Number:

Email Address

Relationship to you:

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* 16. How did you hear about us? Please tick one of the categories below.

(This will help us identify effective communication channels.)

The Leap staff team

The Leap website

Leaflet or Poster

Blog or publication

Another The Leap Award Winner

An event/workshop

Social Media

Other (please specify)

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* 17. Do you have any health limitations we need to be aware of?

Yes

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* 18. If YES are there any reasonable adjustments we can make for you?

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* 19. I confirm that, as far as I know, all the information I have given on this application is true and correct. I understand that you may ask for more information at any stage of the application process. (please enter your name below to confirm)

Do It Thissen Cinema

Question Title

* 1. First Name

Question Title

* 2. Surname

Question Title

* 3. Address and contact details

Question Title

* 4. Where will your film(s) be shown in Bradford District?

Question Title

* 5. If you have a venue, please tell us about it. (350 words max)

Question Title

* 6. Describe why there is a need for a social cinema where you live. How have you identified this? (350 words max)

Question Title

* 7. What social issue will your cinema be exploring? How will social cinema make a difference in your community? (350 word max)

Question Title

* 8. Who are your intended audience? Please tick all relevant boxes.

Question Title

* 9. How will you ensure you will attract diverse audiences?

Question Title

* 10. Tell us about the types of films you would like to screen.Explain why you have chosen these.

Question Title

* 11. What are the discussions/activities that may develop as a result of havinga social cinema in your local area?

Question Title

* 12. What skills/experiences do you hope to learn/develop from your social cinema?

Question Title

* 13. How many viewings would you like funding for?

Question Title

* 14. What would you spend your support money from The Leap on?

Question Title

* 15. Referees: Please provide us with details of two referees who know about your film idea and would be willing to provide a reference. Please check before naming them. Family members are not permissible.

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* 16. How did you hear about us? Please tick one of the categories below.(This will help us identify effective communication channels.)

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* 17. Do you have any health limitations we need to be aware of?

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* 18. If YES are there any reasonable adjustments we can make for you?

Question Title

* 19. I confirm that, as far as I know, all the information I have given on this application is true and correct. I understand that you may ask for more information at any stage of the application process. (please enter your name below to confirm)

* 6. Describe why there is a need for a social cinema where you live.
How have you identified this? (350 words max)

* 10. Tell us about the types of films you would like to screen.
Explain why you have chosen these.

* 11. What are the discussions/activities that may develop as a result of having
a social cinema in your local area?

* 15. Referees: Please provide us with details of two referees who know about your film idea
and would be willing to provide a reference. Please check before naming them.
Family members are not permissible.

* 16. How did you hear about us? Please tick one of the categories below.

(This will help us identify effective communication channels.)