California Clean Air Workshop for Reporters and Editors from Ethnic Media in San Joaquin Valley

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Application Form
Deadline: May 15, 2008
Program Dates: June 19-21, 2008

Date: *

PERSONAL DATA:

Mr or Ms: * Mr.Ms.

Last names: *

First name: *

Date of birth: *

Citizenship: *

Name of media: *

Title: *

Work address: *

Work telephone: *

Work fax: *

Home telephone: *

Mobile number: *

Email: *

How did you hear about this program? *

(If it is a newspaper, please fill out the first three lines. If it is TV or radio, describe below.)

Published how many times per week?:

Sunday edition:

Circulation/audience:

Number of journalists in the newsroom:

Describe your media in detail: *

Language of your media: *

INTERPRETATION:

Do you need Spanish interpretation for training sessions in English? *

(please choose one)

EMPLOYMENT EXPERIENCE:

What is your current position? *

How long have you been in this position? *

Years of work experience in journalism: *

Please describe your primary tasks: *

Describe your previous employment and your responsibilities in those posts:

EDUCATION:

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

EXPERIENCE COVERING ENVIRONMENTAL TOPICS:

Please describe the stories you have done, or want to do, on air pollution: *

Please send us one copy of your published or broadcast story on air pollution (or transcript for radio or TV story).

EMPLOYER AGREEMENT:

Please give the name and contact information for the editor or other supervisor who has approved your participation in this workshop in order to obtain immediate and longer-term stories on air pollution and its effects on ethnic communities.

Name: *

Phone Number: *

E-mail address: *

Please send any additional materials to the address below before May 15, 2008:

Air Cal 3

International Center for Journalists 

1616 H Street, N.W. 

Washington, DC 20006

Tel: 202/737-3700  Fax: 202/737-0530  Email: air@icfj.org

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