Applications from U.S. journalists should be sent to the Burns Fellowship, International Center for Journalists by mail, e-mail or fax no later than March 1, 2007.

Please print out, complete and return this form or copy this form and return by e-mail.

I. PERSONAL DATA

Name:_____________________________________________________________

Date of Birth:________________________________________________________

Citizenship:_________________________________________________________

Current Employer:____________________________________________________

Current Position:_____________________________________________________

Business Address:_____________________________________________________

_____________________________________________________________________

Business Phone:_______________________________________________________

Business Fax:_________________________________________________________

E-mail:_______________________________________________________________

Home Address:_________________________________________________________

______________________________________________________________________

Home Phone:___________________________________________________________

How did you hear about this fellowship program?

______________________________________________________________________

II. EMPLOYMENT EXPERIENCE

Organization:___________________________________________________________

Position and Duties:______________________________________________________

Dates:_________________________________________________________________

Organization:___________________________________________________________

Position and Duties:______________________________________________________

Dates:_________________________________________________________________

Organization:___________________________________________________________

Position and Duties:______________________________________________________

Dates:_________________________________________________________________

III. EDUCATION
(Briefly list any higher education degrees, institutions and dates)

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

IV. INTERNATIONAL EXPERIENCE
(Briefly describe any overseas work or travel, including all previous travel to Germany)

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

V. GERMAN LANGUAGE SKILLS (choose one: none; beginner, proficient, fluent)

Reading:
Writing:
Speaking:
Listening:

VI. PROFESSIONAL & PERSONAL GOALS AND INTERESTS
(Briefly describe any special issues or topics you particularly wish to explore during this program.)

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

VII. AGREEMENT TO PROGRAM CONDITIONS
There is a great deal of opportunity for individual initiative in this fellowship program, but there are several minimum expectations to which participants are asked to adhere. If you wish to be considered for this program, please read and acknowledge the agreement below. If selected to be an Arthur F. Burns Fellow:

I agree to foster and endorse the overall goals of the program, which are to increase awareness and knowledge of Germany and to promote closer and lasting personal contacts with my professional counterparts in Germany.

I understand that this is a professional training program in which work is required. If selected for this fellowship, while I am affiliated with a German news organization selected by the sponsors, I agree to work for approximately half of the time on news coverage for my home news organization. Furthermore, I agree to work and/or observe journalism practices in Germany for approximately half of the time at the host news organization, serving in effect, as a temporary staff member. I understand that, although I may want to work in a particular region or city in Germany, my preferences will be considered but not guaranteed.

I agree to participate in a group orientation in Washington, D.C., beginning on July 25, 2006, prior to my departure for Germany.

I agree to provide, by November 1, 2007, a written report to the Fellowship administrators about my European experience.

I understand that the program administrators will provide me with a stipend in the amount of $4,000 and travel allowance in the amount of $1,000 to cover my international and domestic program travel and basic living expenses during my fellowship. In addition, I may require some German language instruction prior to the fellowship to increase my proficiency, the sponsors will help fund such instruction, up $500.

Because the purpose of the program is to enhance understanding between journalists in the United States and Germany, all travel, personal and professional, undertaken during the fellowship time frame is restricted to Germany unless approval has been granted in advance by program administrators.

I agree to state my qualifications accurately in the application process, particularly in regard to proficiency in the German language.

I HAVE READ AND AGREED TO ADHERE TO THE ABOVE GUIDELINES IF I AM SELECTED FOR THE 2007 ARTHUR F. BURNS FELLOWSHIP.

Applicant's Signature :____________________________________________________

Date:_______________________________________

NOTE:
Send your application package to The Arthur F. Burns Fellowship c/o International Center for Journalists. Please include five copies of the following:

• A letter explaining why you should be selected for this fellowship
• An up-to-date curriculum vitae
• Three samples of recent work as they appeared in print or were broadcast (home-use audio cassette and NTSC videotape formats only please)
• A letter of recommendation from your direct supervisor