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This application is for U.S. participants only.

For help with this form or questions about the program please
email halbiety@icfj.org or call 1.202.349.7625

I. PERSONAL DATA

Name:

Date of Birth:

Gender:

Current Employer:

Current Position:

Employer's website:

Journalists from all types of news media are eligible for this program. Please describe your media organization. What is its estimated audience or hits? What would you like to tell us about your media organization?

If a freelancer, please describe the organizations you work with.

Tell us about your responsibilities. Do you supervise others in the newsroom? How many? If you are a reporter, editor or producer, what do you cover? What else would you like to tell us about your job?

Your Address:

Phone:

Mobile:

Fax:

Email:

Do you have any health condition or dietary needs that could be a factor during an extended stay abroad? (Please note: This question is optional.)

Do you use Facebook, LinkedIn, Twitter, or any other social networks? If so, please tell us how to find you.

II. EMPLOYMENT EXPERIENCE

Start with most recent.

Organization (I):

Position and Duties:

Dates:

Organization (II):

Position and Duties:

Dates:

Organization (III):

Position and Duties:

Dates:

III. EDUCATION

Briefly list any higher education degrees, institutions and dates.

Start with most recent.

IV. INTERNATIONAL EXPERIENCE

Briefly describe any previous overseas work or travel.

VI. PROFESSIONAL AND PERSONAL GOALS AND INTERESTS

In no more than 500 words, please elaborate briefly on your professional skills and how they would be applicable to meeting the goals of this program?

VII. REFERENCES

Please provide two references.

Reference 1

Name:

Email:

Phone:

Organization and Title:

Reference 2

Name:

Email:

Phone:

Organization and Title:

How did you hear about this program?

Story Proposals

Please describe in detail the story ideas/topics you would focus on while in Japan. The topics should underline the social, environmental, energy and economic impacts of Japan’s continuing crisis stemming from the earthquake tsunami and the nuclear meltdown at the Fukushima Daiichi nuclear power plant. How would you make the stories interesting to a U.S. audience? Who would you try to interview? Where would you need to travel? Please upload as a Word or PDF document.

Freelance Journalists

If you are a freelance journalist, please provide up to three letters of intent from media organizations that are willing to disseminate your work.

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Apply By:

8/9/2012

Dates:

5/1/2012 - 4/1/2013

Region:

Japan

Meet the Fellow:

Olga Belogolova

Olga Belogolova reports on energy and environment policy for National Journal, focusing on how it affects domestic and international politics and economics. She contributes to the Daily, web and magazine and manages the bi-weekly Energy and Environment Insiders Poll. Prior to joining National Journal, Belogolova was the West Coast Editor of Encore Magazine, managing editorial content and new media for the Los Angeles bureau.

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Chris Benderev

Chris Benderev lives in Washington, DC and works as a production assistant at National Public Radio (NPR). There, he writes, produces and directs news and culture coverage for "Weekend Edition." He's also produced for NPR's "Morning Edition," "All Things Considered" and "Tell Me More."

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Joe Rubin

Whether reporting for public radio, television or online, Joe Rubin brings his passion for innovative storytelling to every project he works on. iWitness, the webcam interview series he created and hosted for PBS's Frontline/World, won the 2009 Webby for the best online news and video series.

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