ChangeChitra - Application Form
Email address *
First Name *
Last Name *
Date of Birth *
Gender *
Current Address *
Permanent Address (if different from above) *
State Name *
Contact Number *
Please mention type of id proof you wish to upload *
ID proof number [Ration Card/Pan Card/Passport/Election Card/Driver License/Aadhar Card] *
Please upload image of ID Proof *
Educational Qualification *
Occupation *
College/Organisation (if applicable)
Languages known - Read & Write *
Languages known - Speak & Understand *
Name of Reference #1 (Can be any academic or professional reference) *
Phone Number of Reference #1 *
Email of Reference #1 *
Name of Reference #2 (Can be any academic or professional reference) *
Phone Number of Reference #2 *
Email of Reference #2 *
Do you have any formal or informal training in film-making? If yes, please tell us where and when you did this training : *
Can you operate a video camera? *
Do you know how to record sound on DSLR camera *
Do you know how to script a documentary film? *
Do you know how to edit video? *
If you know how to edit, please list the software you are familiar with *
What according to you is the major social challenge in India? Explain *
List some big social challenge(s) faced by your community and your involvement in solving it *
Where do you see yourself five years from now? *
What obstacles or challenges do you have in achieving your dream mentioned above? *
Mention one documentary film that has inspired you. How? *
What issue/subject would you like to make a documentary film on? Why? : *
What is it that you are looking forward to the most from this program? : *
How do you think documentary films/videos impact the society? *
The ChangeChitra project is spread over 12 months, will you be available for complete tenure of the program? (Click here to check the schedule): *
I have checked the dates and can confirm I am available to attend all three workshops *
I agree to participate in all the online mentoring between workshops. *
I understand I will be required to work on my film in between the workshops. *
I understand that the US Embassy reserves rights over the finals produced as part of this project, including rights over unedited footage as mentioned above. *
Declaration: I hereby agree to have carefully read the FAQs and criteria of the program and thereby agree to abide by them. Also, the information provided by me is all true to my best knowledge. I’m filling up this form as I’m sure of my availability during all the three workshops and the rest of the program. *
Date *
How did you get to know about change chitra? *
A copy of your responses will be emailed to the address you provided.
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