Please fill out this form by December 1, 2021, if you are interested in participating in Academy NEXT.
First Name
*
Last Name
*
Do you go by any other name?
*
Email Address
*
Phone Number Country Code
Phone Number
Branch of Interest
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Actors
Casting Directors
Cinematographers
Costume Designers
Directors
Documentary
Executives
Film Editors
Makeup Artists and Hairstylists
Marketing and Public Relations
Members-at-Large
Music
Producers
Production Design
Short Films and Feature Animation
Sound
Visual Effects
Writers
Gender Identity
Man
Woman
Agender
Non-Binary
Other
Prefer to self-describe
Prefer not to say
Do you identify as transgender?
Yes
No
Prefer not to say
Sexual Orientation – Please select all that apply.
Bisexual
Gay
Heterosexual / straight
Lesbian
Pansexual
Queer
Other
Prefer not to say
Prefer to self-describe
Are you a person with a disability? Please select all that apply.
Autism / Neurodivergent
Deaf / Hard of Hearing
Blind / Low vision
Mobility impairment
Physical disability
Chronic Illness or pain
Mental health condition
Speech-related disability
Cognitive disability
Learning / behavioral disability (i.e. dyslexia, ADHD)
Other
None of these apply
Prefer not to say
Race / Ethnicity – Please select all that apply.
African American / Black / African and or Caribbean descent
Asian / Asian American
East Asian (including Chinese, Japanese, Korean, and Mongolian)
Hispanic / Latinx
Middle Eastern / North African
Indigenous Peoples (including Native Americans and Alaskan Natives)
Pacific Islander
South Asian (including Bangladeshi, Bhutanese, Indian, Nepali, Pakistani, and Sri Lankan)
Southeast Asian (including Burmese, Cambodian, Filipino, Hmong, Indonesian, Laotian, Malaysian, Mien, Singaporean, Thai, and Vietnamese)
White
Other
Prefer not to say
Prefer to self-describe
Nationality
Afghan
Albanian
Algerian
American
Andorran
Angolan
Anguillan
Argentine
Armenian
Australian
Austrian
Azerbaijani
Azerbaijani
Bahamian
Bahraini
Bangladeshi
Barbadian
Belarusian
Belgian
Belizean
Beninese
Bermudian
Bhutanese
Bolivian
Botswanan
Brazilian
British
British Virgin Islander
Bruneian
Bulgarian
Burkinan
Burmese
Burundian
Cambodian
Cameroonian
Canadian
Cape Verdean
Cayman Islander
Central African
Chadian
Chilean
Chinese
Citizen of Antigua and Barbuda
Citizen of Bosnia and Herzegovina
Citizen of Guinea-Bissau
Citizen of Kiribati
Citizen of Seychelles
Citizen of the Dominican Republic
Citizen of Vanuatu
Colombian
Comoran
Congolese (Congo)
Congolese (DRC)
Cook Islander
Costa Rican
Croatian
Cuban
Cymraes
Cymro
Cypriot
Czech
Danish
Djiboutian
Country of Residence
United States
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Republic of the)
Costa Rica
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic People’s Republic of Korea
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Lao People’s Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia (Federated States of)
Monaco
Mongolia
Montenegro
Morocco
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Macedonia
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Republic of Moldova
Republic of Mozambique
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Thailand
Timor Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United Republic of Tanzania
Uruguay
U.S. Virgin Islands
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Yemen
Zambia
Zimbabwe
Number of Credits (if applicable)
Years of Experience
*
Link to Professional Profile (IMDB, LinkedIn, Other)
*
Describe why you are a candidate for Academy NEXT:
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Have you previously been involved in any Academy programs? Please select all that apply.
Academy Gold Rising
Academy Nicholl Fellowships in Screenwriting
Student Academy Awards
Academy Gold Fellowship for Women
Careers in Film Summit
In what programs would you be interested in participating? Please select all that apply.
Masterclasses
Mentorship
Mixers
Panels
Workshops
Virtual conversations