Journalist Award Submission

First Name: *

Last Name: *

Gender: *

Age: *

Nationality: *

Country of Residence: *

Home Address: *

Phone Number: *

Fax Number:

E-mail Address: *

Applicant Data

CV:

Identity Document:

Data of Journalistic Work

Title: *

Media where it appeared: *

Category:

Please choose which category you would like to submit to, you can choose more than one.

URL:

For Blogs, Youtube videos, pictures, podcasts and other online media: (If your journalistic work is available online, include the URL)

Team members:

Please enter the names of any team members if relevant.

Attach Journalistic Work:

Attach an original copy of your article or audiovisual work in any of the following formats: PDF, Word Doc, MP3, AVI, MPG, Quicktime, Windows Media

Script/Translation:

Attach a script or translation in English or French in case the journalistic work is in different language

Journalist Award