International Journalism Exchange

International Center for Journalists

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2007 INTERNATIONAL JOURNALISM EXCHANGE

Program Dates: October 8-November 7
Application Deadline: June 1, 2007

PERSONAL: Family Name: *
Given Name: *
Mr. or Ms.*
Date of Birth (month/day/year - please spell out the month): *
Name of Your Newspaper: *
Your Position/Title: *
Work Address (please include COUNTRY): *
Work Phone (please include COUNTRY CODE): *
Work Fax (please include COUNTRY CODE): *
E-Mail: *
Home Address: *
Home Phone: *
Mobile Phone:
Home/Private E-Mail:*
Please indicate address we should use for correspondence:*
Citizenship: *
Passport Number: *
How did you find out about this program?*

FACTS ABOUT YOUR NEWSPAPER Frequency of publication:*
Other
Single issue circulation: *
Sunday edition? *
Number of newsroom staff: *
Language(s) of publication: *
Ownership:*
Other
Describe your media organization: *
Internet address (URL) of your newspaper: *

EMPLOYMENT EXPERIENCE What is your current position? *
How long have you held your current position? *
How many newsroom staff members do you supervise?*
How many years as a journalist? *
Please describe your main work responsibilities:*

Briefly list previous employment, positions held and dates: i. Position:*

Employer:*
Start date:*
End date:*
ii. Position:*
Employer:*
Start date:*
End date:*
iii. Position:*
Employer:*
Start date:*
End date:*

EDUCATION Briefly list any higher education degrees, institutions and dates*

LANGUAGE

English proficiency:

Listening:*
Speaking:*
Reading:*
Writing:*

Other languages:�Native: *Other:*

INTERNATIONAL EXPERIENCE Please describe any overseas work or training, including all previous travel to the United States.*

ESSAY - Professional Goals and Interests

To be considered for this program, applicants must explain why they wish to participate in the program, what they hope to accomplish, what they want to learn at the American newspaper to which they will be assigned, and how the experience would help their news organization. A minimum of 300 words is expected, though applicants may write longer. Please attach your essay here.

2007 IJE AGREEMENT TO PROGRAM CONDITIONS

A. APPLICANT'S STATEMENT

I, the undersigned, understand and agree to the following conditions of the 2007 International Journalism Exchange:

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

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

3. The organizers will pay for round-trip economy airfare to and from the United States; housing; ground and air program-related travel expenses within the United States; a per day meal/living allowance; and health insurance for the duration of the program. I will assume responsibility for all incidental expenses. (The program cannot cover salary or pay honoraria.)

4. If chosen, I will be responsible for all passport and visa arrangements, and required fees.

5. If chosen, I am required to return to my home country after the completion of the program.

6. If I extend my stay in the United States before or beyond the program, I agree to pay the cost of extending my insurance policy.

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 these rules will be expelled from the program.

Please type your name and today's date in the box below. This will prove as an electronic signature and is your written consent to the above conditions.

Your employer's signature must be sent in on a separate form. This form can be downloaded from the ICFJ Web site.

Name and date:*
If you have questions please contact:
Ms. Ting Wang
Program Officer
International Journalism Exchange
International Center for Journalists
1616 H Street, N.W., Washington, DC, 20006 U.S.A.
Tel: +1-202-737-3700
Fax: +1-202-737-0530
E-Mail: ije@icfj.org
www.icfj.org/ije.html
www.ijnet.org

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