Application for the African Centre for Media Excellence Local Government Fellowship for Journalists 2015

Bio data

This is a lengthy application form. It will take between 30 minutes and one hour for you to complete it, so please find sufficient time to complete it in full.

Provide ALL information. The more detailed your application is, the higher your chances of selection for this fellowship programme.

Incomplete forms with unanswered or partially answered questions will not be considered at all.

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* 1. First Name

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* 2. Last Name

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* 3. Gender

Female

Male

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* 4. What is your age?

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* 5. Primary email address

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* 6. Alternate Email Address

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* 7. Primary Phone Number

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* 8. Alternative Phone Number

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* 9. Name, address and phone number of the newspaper, radio, TV station or online news platform for which primarily work.

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* 10. What is your current position at the media house named above?

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* 11. How long have you been in your current position?

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* 12. What is the name of the town or city in which you work?

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* 13. Name and position of your editor, manager or editorial supervisor

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* 14. Phone number and email of your editor, manager or editorial supervisor