Next Generation Media Application Form - Centre for Multicultural ...

Next Generation Media Application Form
Please complete and submit the following application form. These details will not be disclosed to
anyone outside of the Next Generation Media project partners who are the Centre for Multicultural
Youth (CMY), SYN Media and the National Ethnic and Multicultural Broadcasting Council (NEMBC) as
well as our associated partner the Multicultural Media Exchange (MME) without your prior
permission. Please print CLEARLY.
Name
Gender
Date of birth / /
Cultural background
What language/s do
you speak at home?
Address
(with postcode)
Home phone number
Mobile phone number
Email address
What are the best ways
to contact you?
How did you hear about
Next Generation Media?
Why do you want to be
part of this training
project?
Home phone number Mobile number
Email Facebook

What do you think
about the
representation of young
people in the media?
What are you interests
in radio?
What do you hope to do
with your skills and
knowledge after the
project finishes?
To be part of the program you need to make the following commitment:
1. Be available to participate in the program from January 2012 to May 2012
This includes 4 days a week for 4 hours between the 16 to 30 January 2012 and a commitment of a
1 hour radio program weekly for 3 months (February to April).
Applicant Name _________________________________________ (print name)
Applicant Signature _______________________________________ (sign)
(If under 18 years old, parent/guardian to sign)
Parent/Guardian _________________________________________ (sign)
If you have any questions or would like any more information, please contact Bree McKilligan
Email: bmckilligan@cmy.net.au Phone: 9340 3700 Mobile: 0419 779 553
Centre for Multicultural Youth
304 Drummond Street
Carlton Victoria 3053 Australia
PH: (03) 9340 3700 Fax: (03) 9349 3766
www.cmy.net.au
This is a joint project between the Centre for Multicultural Youth (CMY), The National Ethnic and
Multicultural Broadcasters’ Council (NEMBC) and SYN Media