115 West 29^th Street, Suite 606

New York NY 10001

Phone: 212 279 1442

www.indypressny.org

Ethnic and Community Press Fellowship 2010 – Developing an Education Beat

Personal Information

*Last Name: _________________ *First Name: _________________________

*Title / News Beat: __________________________________________________________

*Name of Publication / Affiliation: _______________________________________________

*Employer's Address:

_________________________________________________________________________

(Street name & number) (floor/suite)

_______________________ ________________________ ________________

(City) (State) (Zip)

Contact Information

*Mailing Address (Please check here __ if it is same as your employer's address)

_______________________ _______________________________________

(street name and number) (floor/suite)

________________________ _____________________ __________________

(city) (state) (zip code)

*Tel. Number: ______________________ /___________________________

(office) (cell)

*Email Address (primary): __________________________________________

…

Why do you wish to participate in the Fellowship?

Why are public education issues and school reform important to you? What do you expect to learn from this Fellowship? What education-related subjects do you intend to address in your Fellowship stories? (Please explain in 500-600 words)

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This application should be accompanied by:

• Journalists with English language publications are required to submit three news clips.

• Journalists writing for non-English publications need to submit one translated article/clip

• All applicants must include a letter of recommendation from their publisher.

Please read the Fellowship Requirements document before signing below.

Name_______________________________________________

                                (Please print your name)

Signature_____________________________             Date__________________

Completed application form along with supporting documents can be mailed:

New York Community Media Alliance

115 W 29th St.

Suite 606, New York, NY 10001

E-mailed: nycomm@indypressny.org

Faxed: 212 239-8571

For additional question or information, please call Jehangir Khattak, Communications Manager, at 212-279-1442 or at nycomm@indypressny.org