application forms - Internews in Kenya
application forms - Internews in Kenya
application forms - Internews in Kenya
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
• A completed Fellowship Application (below)• Two recent examples of your work published or aired <strong>in</strong> the past 12 months(more guidel<strong>in</strong>es <strong>in</strong> the <strong>application</strong> below)Note: Freelance journalists are welcome to apply, but must provide a letter of support<strong>in</strong>dicat<strong>in</strong>g that their stories will be published or broadcast and that they are on contractwith an established, ma<strong>in</strong>stream media outlet <strong>in</strong> their country of orig<strong>in</strong>.Applicants will be notified by Friday August 10, 2012I. Background Information1. Name:2. Name of Media house:3. Type of Media (Pr<strong>in</strong>t, onl<strong>in</strong>e, radio, TV etc):4. Media House Distribution/Audience Reach 300,0005. Geographic reach of your Media House :Local National Regional International6. Title:7. Address:8. Email:9. Phone:10. Which country are you from?Brazil Cambodia Ch<strong>in</strong>a Egypt <strong>Kenya</strong>Mexico Russia Turkey VietnamOther (please specify)11. Are you currently liv<strong>in</strong>g and work<strong>in</strong>g <strong>in</strong> this country? Yes No12. Do you have a valid passport? Yes No Expiration date: yyyy-mm-dd
13. What is your beat/ area of expertise as a journalist:14. What language do you report <strong>in</strong>?15. Please <strong>in</strong>dicate your English read<strong>in</strong>g, writ<strong>in</strong>g and speak<strong>in</strong>g level .Read<strong>in</strong>g:BasicWrit<strong>in</strong>g:Writ<strong>in</strong>g:Intermediate Advanced Fluent Native SpeakerBasic Intermediate Advanced Fluent Native SpeakerSpeak<strong>in</strong>g:Basic Intermediate Advanced Fluent Native Speaker16. Have you ever produced or written stories focused on traffic, road conditions,safety or <strong>in</strong>jury prevention (<strong>in</strong> particular violence, drown<strong>in</strong>g and burns)? If yes,please briefly describe. (Max 50 words)
II. Support from your Editor17. As part of this <strong>application</strong> form, all applicants are required to provide a supportletter from their editor, producer, or supervisor. This letter should clearly statethat your Editor has agreed to guarantee pr<strong>in</strong>t space or air time for storiedproduced on the conference. Is your letter attached to this <strong>application</strong>?YesNoIII. Examples of your Work18. Applicants must provide two samples of their work, published or aired with<strong>in</strong> thelast 12 month that are focused on public health. If your work is not <strong>in</strong> English, youmust provide an English translation or summary along with your published work.Have you attached two samples of your work?YesNoSample 1:Title:Media: (radio, TV, pr<strong>in</strong>t, onl<strong>in</strong>e etc...)Date published/aired:yyyy-mm-ddFocus of story:Sample 2:Title:Media: (radio, TV, pr<strong>in</strong>t, onl<strong>in</strong>e etc...)Date published/aired:yyyy-mm-ddFocus of story:
IV. Essay Question19. In a brief, 350 word essay, please discuss why you would like to be consideredfor this scholarship and what impact your work has had on policy and/or publicawareness <strong>in</strong> your country. Please be sure to cite specific examples of storiesyou’ve done that have had an impact on local, national or regional policies. Inyour essay please also describe what you believe to be the role of the media <strong>in</strong>cover<strong>in</strong>g traffic safety issues and what impact you th<strong>in</strong>k media coverage couldhave on this issue. (Please provide your response <strong>in</strong> the text box below. max350 words)
Change language