APPLICATION (TYPE OR PRINT CLEARLY)

African Women’s Media Center (AWMC)
Training program on Reporting on HIV/AIDS
for women radio journalists from Southern Africa

Program Dates: June 18, 2002- June 29, 2002
Application Deadline: Friday, May 24, 2002

To apply to be a delegate for this program, please complete the following form and return it to the AWMC via fax: 27-11-327-0242, or email Gifti Nadi: gnadi@iwmf.org. You may also apply on the AWMC website at www.awmc.com. The application deadline is Friday, May 24, 2002.

APPLICATION REQUIREMENTS (Your application must include the following)

1. Complete application form [    ]
2. Essay [     ]
3. Current CV [     ]
4. A letter of permission and recommendation from your station manager attesting to your qualifications and how you will benefit from participating in this program Permission to apply for the program MUST be granted by your station manager.
[        ]

PERSONAL INFORMATION

Family name/Last/Surname:                            First Name:________________________
Country of citizenship: _________________Date of Birth:_______________________
How did you find out about this program? ____________________________________

WORK INFORMATION

Name of radio station:____________ Your position/Title: ___________________________
Number of years with station:_________________ Number of employees_______________
How long have you worked as a journalist:________________________________________
Is your station currently on air?_________________________________________________
How many times per day/week do you broadcast?___________________________________
What types of programs do you produce?__________________________________________
How much airtime is allocated to women’s issues?__________________________________
How much airtime is allocated to HIV/AIDS issues?_________________________________
Ownership: ___ State    ____ Private    ____Community   ______Other; Specify___________
Audience: __________________ Approximate audience size:__________________________
Describe your radio station in detail. Does it have a political affiliation?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Describe your current job and responsibilities  ________________________________________  
______________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________

HIV/AIDS REPORTING EXPERIENCE 

Do you currently report on HIV/AIDS? ____Yes _____No
If yes, approximately how many times have you covered HIV/AIDS during the course of the last three months_____________________________________________________________
What type(s) of program format(s) did you use?_________________________________             

TRAINING 

What type of training programs have you participated in? when and where?
____radio training_______________________________________________________________
____basic production techniques ___________________________________________________
____news reporting, features, drama etc______________________________________________ 
____programs on how to report on special issues_______________________________________
If so, please specify issue (HIV/AIDS, business, health, etc)
______________________________________________________________________________

EDUCATION 

Institution: _____________________________________________________________________
Degree (if any) _________________________________________________________________
Date: _________________________________________________________________________
Certificate (if any)_______________________________________________________________	                                    Date:__________________________________________________________________________

Institution:_____________________________________________________________________Degree (if any) _________________________________________________________________
Date:_________________________________________________________________________
Certificate (if any)_______________________________________________________________                                    Date:_________________________________________________________________________

WORK  ADDRESS:  

Street:________________________  City, Country__________________________
Telephone:_____________________ Fax:_________________________________
Email:		__________________Mobile: ________________________________

HOME ADDRESS: 

Street:		______________________ City, Country________________________
Telephone:	______________________ Fax:_________________________________
Email:		______________________ Mobile:_________________________________

(The AWMC must be able to contact you directly at one of the addresses/phone numbers listed)

COMPUTER EXPERIENCE

Do you  work on a computer? ________  If yes, at HOME  or WORK? (Circle One)
Do you have access to the Internet through your job? _______  At home? Yes ____ No___
If no, where do you go to access the computer? ___________________________________
Do you use the Internet to conduct research for stories? _____________________________

PROFESSIONAL ASSOCATIONS

Do you belong to any women’s media organizations?  Yes ___  No ___
If yes, please name ___________________________________________

Do you belong to any other media organizations? Yes __ No___ 
If yes, please name ____________________________________________

ESSAY: (Please Type on a separate sheet)

Write a 300 word essay addressing all of the following topics:

Why you believe women radio journalists should receive training in HIV/AIDS reporting
Your level of knowledge of HIV/AIDS and topics you would like to see addressed in this program
What your vision is for your career in the media
How you believe that participating in this program will help you achieve your goals