<p> ENTRANCE AUDITION APPLICATION REQUEST</p><p>CENTRE NATIONAL DES ARTS DU CIRQUE Recent Identity photo</p><p>National school for circus arts studies in Châlons en Champagne</p><p> first application  Previous application(s), year(s) : ……………</p><p>Chosen spezialisation :</p><p>Candidate’s identity Miss / Mrs / Mr * SURNAME : Firstname(s) : Birthday : Age in 2011 : Department (or country) : Nationality : Mother tongue : Other spoken language(s) : Address : Country : Tel : Mail : Mobile :  single*  divorced (e)  married (e)  other Do you have any dependent? Military service* :  Carried out  Exempted  Free of military obligations  Deferred to : date  Reformed Person to notify in case of emergency: Tel : Father (SURNAME firstname): Mother (SURNAME firstname) Profession : Profession : Address : Address :</p><p>Country : Country : Tel : Tel : Mobile : Mobile : How many children are dependent of your parents (included you)? Academic level Obtained  A level Section : Obtained year : diplomas* :  Superior studies : Obtained year :  Other diplomas, obtained certificates : I am undertaking at present* :  A level Section :  Others : I stopped my schooling before high school : Name of school : Name of School’s Director : Tel : Other obtained diploma / certificate : All candidates with foreign diplomas must obtain from French consular authorities a certificate of equivalence. Are you registered in any courses preparing for Entrance auditions for Circus arts? If yes, which school ? (You must put the stamp of the school preparing for Entrance auditions for circus arts and the signature of the Director or the Head of the studies department) Since when? If not, are you registered in any circus school? If yes, which one? Since when? Medical information Weight : Height : Branch office : Address : Address : Personal doctor : Tel. : Address : * underline the necessary mention Extra-curriculum activities Could you please indicate, with a maximum of precision (number of years), your different artistic and/or sports activities</p><p>Year(s) Number of Discipline Names and locations of the schools annual hours Teacher’s names Circus techniques / Acrobatics</p><p>Music</p><p>Dance</p><p>Acting</p><p>Other artistic disciplines and complementary information Questionnaire In which circus discipline do you wish to specialise in Châlons? Why? Since when did you practise this discipline? Could you please explain what is your artistic project applying for this school?</p><p>Describe your motivation for circus arts :</p><p>What shows or artistic actions have impressed you the most? And why? If you have already had professional experience connected with circus, theatre, dance or any other artistic fields, please describe the establishment and companies you worked with, the artistic actions you presented and the periods.</p><p>When, how and through who did you learn of the National Centre for Circus Arts?</p><p>Organism / Name of the person : Address :</p><p>To send by e-mail at [email protected] To send by post</p><p>- Application form - 1 DVD or a VHS video cassette (enclosed the descriptive list) - Complementary form request to complete only by - 50 € for the inscription expenses by international transfer candidates who don’t have the A-level or an equivalent (you must set in charge spending expenses) Bank details below IBAN : FR48 3000 2079 3100 0007 9508 W64 BIC : CRLYFRPP - 3 identity recent photos (not including first page photo of this file) - Photocopies of diplomas and/or graduation certificates - All candidates with foreign diplomas must obtain from French consular authorities a certificate of equivalence (French bacca- lauréat) - For all applicants (girls or boys), proof of military status - 1 recent medical certificate of not contraindication in the extensive practice of physical and sports activity delivered by a sports medicine doctor</p><p>This form must be completed any returned (accompanied if necessary by the complementary admission form for the persons who don’t have the A level, which will be examined by a commission, which will valid or not the request)</p><p>Before March 18th, 2011</p><p>I certify, on my honour, that all information contained here in is correct : Signature :</p><p>Signed in : Date :</p><p>Centre national des arts du cirque – 34, avenue du Maréchal Leclerc – 51000 Châlons en Champagne Site : www.cnac.fr – E-mail : [email protected] Tel. : 00 333 26 21 12 46 - Fax. : 00 333 26 21 80 38</p>