Faith in the Media

Application deadline: September 1, 2008

Program for which you are applying

Full Name:

First Name

Last Name

Date of Birth

Country of Birth

What is your nationality?

How did you hear about the program?

Personal Data

Current Employer

Current Position

Primary Address

Street

City

State/Province

Zip/Postal Code

Primary Phone Number

Primary Fax

Primary E-mail

Secondary Address

Street

City

State/Province

Zip/Postal Code

Secondary E-mail

Mobile Phone

Health (Do you have any health condition or dietary needs that could be a factor during an extended stay abroad?)

Professional Skills

Section V: Languages

Please score yourself in language proficiency, other than English, using the following scale:

1. Elementary Proficiency-Able to satisfy routine travel needs and minimum courtesy requirements

2. Limited Working Proficiency-Able to satisfy routine social demands and limited work requirements

3. Minimum Professional Proficiency-Able to use language with sufficient structural accuracy and vocabulary to participate effectively in most conversations on practical, social and professional topics

4. Full Professional Proficiency-Able to use the language fluently and accurately on all levels pertinent to professional needs

5. Native or Bilingual Proficiency-Equivalent to that of an educated native speaker

Language

Speaking

Reading

Language

Speaking

Reading

Language

Speaking

Reading

International Experience

Briefly list any overseas work or travel you have completed in the past 10 years.

Briefly elaborate on your professional skills indicated above and how they would be applicable to meeting the goals of this fellowship.

Reasons for Applying

In no more than 750 words, please explain your reasons for applying for this particular fellowship at this time.

Curriculum Vitae *

Please attach a resume detailing your professional experience and educational background.

Please attach a detailed description of no more than 800 words of the project that you would like to propose for this joint reporting program. Please see guidelines on main page for details. *

Self-Identification (Optional)

ICFJ is committed to equal opportunity. For informational purposes only, you are invited to identify yourself in certain categories. Please note that you are under no obligation to complete this section. The information or decision not to provide information in this section will not be used as a factor in considering your application.

What is your gender? MaleFemale

Statement of Understanding

Applicants are required to complete the statement of understanding

I, the undersigned, understand and agree that the International Center for Journalists (ICFJ), as program administrator, is under no obligation to select me or any other applicant for the Faith in the Media Program. If selected to be a participant, I will agree to the premises and conditions set forth in the following statement:

1. As a precondition for participation, I agree to: - take part in the conference in Istanbul on dates designated by the administrator and to participate in a joint reporting project.

2. I understand that the program administrator may terminate my participation at any time for reasons that are regarded as detrimental to the fellowship, to be determined at the sole discretion of the program administrator or sponsor.

3. I will be responsible for my own passport and visa arrangements and may be asked to assist with other logistical arrangements related to my specific assignment as determined by the program administrator.

Signature

Date

Contact Information

Need assistance with this form?