87 CENTRAL STREET

HOUGHTON
2198
TEL: 011 483 0880
www.nfvf.co.za

PRIVATE BAG X04

NORTHLANDS
2116
FAX: 011 483 0881
SEDIBA MASTERS PROGRAMME 2013
APPLICATION FORM - WRITERS

The completed application form & all additional documents to be emailed to

Pretty Mthiyane on prettym@nfvf.co.za
Closing date: 23 January 2013, 12h00
SECTION 1: APPLICANT DETAILS
TITLE:

__________________________

FIRST NAMES:

__________________________

PREFERRED NAME:

__________________________

SURNAME:

___________________________

ID NO:

____________________________

POSTAL ADDRESS:

____________________________

PHYSICAL ADDRESS: ___________________________

LANDLINE NO:

____________________________

CELLPHONE NO:

____________________________

2nd Floor, 87 Central Street, Houghton, 2198, South Africa

Private Bag X04, Northlands, 2116, South Africa
Tel: +27 11 483 0880 Fax: +27 11 483 0881 Email: info@nfvf.co.za Website: www.nfvf.co.za
Councillors
Ms Mmabatho Ramagoshi (Chairperson); Mr George Leolo (Deputy Chair); Ms Sandra Gordon; Mr Mohau Mphomela; Adv Rod Solomons
Mr Sello Molefe; Mr Paul Raleigh; Adv Roshan Rai Dehal; Dr Sethe Patricia Makhesha
Ms Trish Downing; Mr Avhasei Mukoma; Ms Gcina Mhlophe-Becker
Chief Executive Officer: Ms Zamantungwa Mkosi

FAX NO:
EMAIL ADDRESS:
GENDER:
PROVINCE:

______________________________
_____________________________
______________________________
_______________________________

DO YOU HAVE A DISABILITY:_______________________________________

(If yes, please mention type of disability)
ARE YOU A SOUTH AFRICAN CITIZEN? _______________________________
If not please state citizenship:
ARE YOU A SOUTH AFRICAN RESIDENT? If not please state country of residence:
_______________________________________________
PLEASE NOTE: DOCUMENTS TO ATTACH
1. One page outline of your film. You may submit up to 3 projects.
Kindly use the provided template from NFVF website
2. COMPREHENSIVE CV