Académique Documents
Professionnel Documents
Culture Documents
Gender:
Landline:
Mobile number/s:
Email Address:
Mailing Address:
Professional or Civic Affiliations:
B. YOUR WORK
B.1. For journalists
Primary Media Agency:
Affiliation of Media Agency (PPI, KBP, NPC,
etc.):
Position:
Number of years employed with media agency: Previous positions held at this media agency:
Name of Editor/Supervisor:
Designation:
Landline:
Mobile number:
Email address:
Mailing Address:
URL:
URL
Number of years as
contributor at website:
D. STATEMENT OF MOTIVATION
Briefly explain why you want to participate in this seminar, what you hope to get out of it,
and how you intend to apply the skills and lessons you will learn. Use a separate sheet if
necessary.
E. PRELIMINARY RESEARCH
Please answer the three questions by filling out the box below. It is important that you
provide data to support your answers. See example.
1. When he ran in 2013, what were the campaign promises that your governor/mayor made as
a candidate?
2. Is he failing or passing in fulfilling those promises?
3. Please provide evidence/data to support your answer.
NAME OF GOVERNOR OR MAYOR: __________________________
MUNICIPALITY/CITY/PROVINCE: ____________________________
Campaign Promises
Made in 2013
1. Improve the health
condition of children in the
municipality
Failing or Passing?
Passing
2. Poverty alleviation
F. PREVIOUS SEMINARS
F.1. Have you participated in previous PCIJ seminars? Yes No
F.2. If yes, please list them below.
PCIJ Seminar Title/Topic
Date
F.3. Please list other journalism and media-related seminars in which you have participated:
Seminar Title/Topic
Organizer/Sponsor
Date
G. REFERENCES
List at least two references with contact details. All fields are required.
G.1. Name:
Agency:
Position:
Landline:
Mobile number:
Email address:
Mailing Address:
G.2. Name:
Agency:
Position:
Landline:
Mobile number:
Email address:
Mailing Address:
H. WORK SAMPLES
Please include one or two samples of your work discussing public policy, development, human
rights, or governance issues.
- For print and online: link to the stories or copies of stories in Word or PDF
- For TV and radio: link to the broadcast story; script or story concept/treatment sent via email as
attachment; recording of TV or radio program/segment may also be sent to PCiJ.