Generate Application Form Autumn 2021

Name*

First Name Surname

Address*

Street Address Address Line 2 City County Post Code Country

Contact Phone Number*

Email Address*

Date of Birth*

Under 18 Parental/Guardian Consent*

If you are are under 18 years old we require parental/guardian permission.

Parent/Guardian First Name Parent/Guardian Surname

Guardian Contact Number*

Guardian Email Address*

Parent/Guardian Declaration*

I confirm the above details are correct and consent to the applicant taking part in Generate. I agree that DanceXchange may hold this data for the purpose of managing the CAT programme.

I'd like to apply for a Bursary Place?

DX believes there should be a better representation of our society in dance, so we are offering two bursaries for West Midlands based dancers. The DX bursary will cover the full cost of Generate (from 3 March -14 July) Burseries are open until 24 Feb, you will be notified by 29 Feb if successful. Please select one bursary criteria below:

I live in Washwood Heath, Sparkbrook, Nechells, Aston, Ladywood, Small Heath, Soho, Shard End, Yardley or Handsworth
I am in receipt of free school meals
I identify as LGBTQI+
I have a disability
I am a young person in care
I am a young carer

Dance Experience

Please complete this section as fully as possible. If you have any questions about this secton please email cat@dx.dance.

Tell us about you*

We would like to hear about your dance/movement/sports experience and ANY styles of dance you have taken part in

Why Generate?*

Tell us what interests you about Generate and what you hope to gain from taking part.

What do you love most about dancing?*

Share your footage!*

Please submit a 60 second video of you dancing, either improv or something you might have created yourself, which expresses who you are. Please insert a link here to a video or a download using WeTransfer. Alternatively, send a downloaded file separately via email to cat@dx.dance.

Gender*

Male
Female
Non-binary
Prefer not to say

Do you have any medical conditions, disabilities, specific needs or access requirements that we should be aware of?*

Prefer not to say
Non-disabled
Visual impairment
Hearing impairment/deaf
Physical disabilities
Cognitive or learning disabilities
Mental health condition
Other long term/chronic condition

Ethnicity*

How would you describe your ethnic origin? Please tick the box that relates to you. (Note. These are categories recommended by the Arts Council England).

How did you hear about Generate?*

Please tell us how you heard about the project.

Declaration*

I confirm that the details on this form are correct and I agree that DanceXchange may hold this data for the purpose of managing and keeping in touch with me about the Generate and the CAT programme. I understand that my details will be held in accordance with the GDPR and will not be used for marketing purposes.