MEDIANE European Exchanges of Media Practices (EEMPs) Registration Form

Dear applicant,

To help us with the selection process, please provide some information about you, your organisation, your professional interest and your possible contribution to the MEDIANE Programme. Please note that you will have to fill-in the application form in one session as it cannot be saved until fully completed.

Kindly submit this application at least 6 weeks before your first suggested exchange travel date if you have a partner. If you do not have a partner, please keep in mind that the partner search process may take some time.

For your information, kindly note the following:

-- Questions starting with (*) are obligatory
-- Answers to questions with (**) in the end, may be published unless you send us a notification of refusal
-- Incomplete registration forms will not be considered

A confirmation of your participation will be sent within at least 3 weeks from the date you submit this application.

Thank you for your interest.

MEDIANE team

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1. Title on identification documents (passport or ID card) used for travel purposes
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2. Family name**
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3. First name**
4. Type of organisation
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5. Name of your organisation** (when applicable, write 'freelance')
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6. Your position in the organisation** (e.g. Freelance Journalist, Editor in Chief, Journalism Trainer, Journalism Student, Member of Regulatory Body, etc.)
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7. Personal Address
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8. Post code
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9. Town/City**
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10. Country**
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11. Telephone Number (please include the international dialing code but do NOT add the 00, plus sign (+), other symbols or spaces. Ex. for France: 3312345678)
12. Mobile phone number (please include the international dialing code but do NOT add the 00, plus sign (+), other symbols or spaces. Ex. for France: 3312345678)
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13. E-mail address** (This address may be published for networking purposes - It will be your main email address of communication for the Council of Europe)

14. Other e-mail address, if any (This will remain private)

15. Website**
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16. Address (organisation)
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17. Post code (organisation)
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18. Town/City** (organisation)
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19. Country** (organisation)
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20. Telephone Number (organisation) (please include the international dialing code but do NOT add the 00, plus sign (+), other symbols or spaces. Ex. for France: 3312345678)
21. Fax number (organisation)
22. Website** (organisation)
23. Contact Person within your Organisation
24. E-mail address of the contact person within the organisation

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25. Personal Biography (~150 words) ** This text will be published as you write it - Please do NOT write in caps and do not add bullets.

Please describe your professional and academic background and relevant working experience in relation to the objective of the MEDIANE Programme to include diversity and non-discrimination as ongoing angles in media content design and production. Also include your motivation for wanting to participate in this exchange.
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26. Organisation Biography in English and in French if possible (~150 words) ** This text will be published as you write it - Please do NOT write in caps and do not add bullets.

What kind of organisation are you working for? Please describe the working areas of your organisation in relation to the objectives of the MEDIANE project. Please mention any other criteria if necessary and important.
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27. Who would you like to work with? (~150 words) **

Please describe in this section the person and/or organisation you would like to collaborate with.
If you already have a partner please complete the following:
28. Family name (partner)
29. First name (partner)
30. Name of his/her organisation (when applicable, write 'freelance')
31. Town/City (partner)
32. Country (partner)
33. Telephone Number (partner)
34. E-mail address (partner)
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35. Draft Work Proposal (~ 150 words)

Please describe in this section the main objectives and expected results/products of your proposed exchange.
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36. Advert for the “Matching Service” (not more than 150 words) **

MEDIANE offers a “Matching Service” on the homepage which enables participants to search for exchange partners by posting an advert. Provide a short text for the “Matching Service” stating your project idea, relevant personal and professional data, possible working languages, possible dates for the exchange etc. Your email will be published here in order for other participants to contact you.
A Facebook group to help you to find a partner

Join the Facebook group "European Journalists for Diversity" : www.facebook.com/groups/journalistsfordiversity

This group is related to the MEDIEANE activities and includes around 400 European journalists. You can post your advert there as well. Remember to include details on your preferred exchange partner, topic etc.
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37. Mother tongue:
38. Other language : Indicate competency on a scale of 1 to 5 (1 - excellent; 5 – basic)
39. Other language : Indicate competency on a scale of 1 to 5 (1 - excellent; 5 – basic)
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40. Please indicate how you learned about these exchanges (name organisation or person when applicable)
Should you have any further questions, please consult the F.A.Qs online: http://www.coe.int/t/dg4/cultureheritage/mars/mediane/source/eemp/FAQs_en.pdf , or get in contact with the MEDIANE team via Email: mediane@coe.int. Please find here the Terms and Conditions for Participants in the European Exchanges of Media Practices (EEMPs) here Link to the Terms/Conditions
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41. Any products, resulting from this exchange, or produced by participants during the exchange, may be published and circulated by the Council of Europe and its partners for non-commercial use, and will carry a royalty-free license.
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