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Application Deadline: July 1, 2013

The 2013 Douglas Tweedale Memorial Fellowship

APPLICATION DEADLINE: JULY 1, 2013

I – PERSONAL DATA

LAST NAME:

FIRST NAME:

GENDER (M/F):

DATE OF BIRTH:

CITIZENSHIP/PASSPORT NUMBER:

CURRENT EMPLOYER:

CURRENT POSITION:

BUSINESS ADDRESS:

TELEPHONE:

FAX:

OTHER (E-MAIL, ETC.):

HOME ADDRESS:

TELEPHONE:

FAX:

OTHER (E-MAIL, ETC.):

PLEASE INDICATE ADDRESS WE SHOULD USE FOR CORRESPONDENCE:

HOME:WORK:

How did you hear about the program?

From ICFJ fellowship alumniFrom ICFJ newslettersICFJ Website or IJNetOther

II - EMPLOYMENT EXPERIENCE

HOW MANY YEARS HAVE YOU WORKED AS A JOURNALIST?:

CURRENT EMPLOYER:

ORGANIZATION:

POSITION:

DATES:

TYPE OF MEDIA (NEWSPAPER, TV, ETC.):

CIRCULATION:

PUBLIC OR PRIVATE OWNERSHIP:

NUMBER OF JOURNALISTS IN NEWSROOM:

DAYS PER WEEK YOUR PUBLICATION IS DISTRIBUTED/AIRED:

DIGITAL MEDIA SKILLS:

PLEASE DESCRIBE YOUR ORGANIZATION:

PREVIOUS EMPLOYERS:

ORGANIZATION:

POSITION:

DATES:

ORGANIZATION:

POSITION:

DATES:

III - EDUCATION

BRIEFLY LIST ANY HIGHER EDUCATION DEGREES, INSTITUTIONS AND DATES.

IV - INTERNATIONAL EXPERIENCE

BRIEFLY DESCRIBE ANY OVERSEAS WORK OR TRAINING, INCLUDING ALL

VI - ESSAY

Please attach a one-page essay explaining why you wish to participate in the program, what you want to learn during the fellowship in the U.S. and how you will use this experience and digital media skills to help your news organization.

VII – SAMPLES OF WORK

Print media applicants should submit 3-5 examples of articles they have written. Broadcast applicants should submit 3-5 written transcripts of their programs.

VIII - COMPLETED APPLICATION

Completed applications must be submitted on or before July 1, 2013 to: Johanna Carrillo, Senior Program Director, jcarrillo@icfj.org

AGREEMENT TO PROGRAM CONDITIONS

I, the undersigned, understand and agree to the following conditions of the 2013 Douglas Tweedale Memorial Fellowship:

• If chosen to be a participant, I will be required to spend three weeks full-time in the United States, participating in all aspects of the fellowship.

• I fully understand and agree that it is a condition of this fellowship that spouses or dependents cannot be included nor be accommodated in the program.

• The organizers will pay for round-trip economy air fare to and from the United States; program-related travel expenses within the United States and the site of the second program attachment; a housing and meal allowance; and health insurance for the duration of the program. I will assume responsibility for all incidental expenses.

• If chosen, I am required to return to my home country and my current employment after the completion of the program.

Participation in this program is contingent upon my ability to meet all requirements. I certify that all statements in my application are true, to the best of my knowledge. I understand that any participant who violates this rule will be expelled from the program.

SIGNATURE:

DATE:

EMPLOYER’S STATEMENT:

Yo, el abajo firmante y empleador de:

(nombre del aplicante)

un aplicante en el Douglas Tweedale Memorial Fellowship de 2013, estoy enterado de que si él/la aplicante es aceptado(a) que él/ella tendrá que permanecer por seis semanas en los Estados Unidos y en otro país en América Latina. Yo estoy deacuerdo con eximirlo(a) de sus responsabiidades rutinarias y aseguro que no le asignaré ningún proyecto especial que interfiera con este programa. Además, yo entiendo que los participantes del programa deben retornar a su posición original. Yo, mantendré la posición del aplicante hasta que el progama haya concluido.

Nombre:

Fecha:

Firma:

Teléfono:

Organización:

DIGITAL MEDIA SKILLS:

Need assistance with this form?

Dates:

10/2/2013 - 10/22/2013

Regions:

Latin America
United States

RT @USEmbassyQ8: Clip of @CNNireport's @lilacina on citizen journalism: http://t.co/BtZ4KItMBA. Full video w/ @ICFJ's @SharonMoshavi: http:/
@ICFJ
Here are 10 good reminders for all journalists, no matter where you are in the world! http://t.co/DBFed6yxnJ
@ICFJ
Congrats to @ICFJKnight fellow @Mblejman and partners on the launch of #HacksHackers Rosario! http://t.co/w3GPteOzPD
@ICFJ

Johanna Carrillo, Senior Program Director
jcarrillo@icfj.org

2000 M Street, N.W. Suite 250

Washington, D.C. 20036

The 2013 Douglas Tweedale Memorial Fellowship

Dates:

Regions:

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