OAG HAMMARSKJOLD JOUFINAWSM FELLOWSHIP APPLlcAnorJ

[l<o;o~Ii. . 10' Su_.l<ln. Ap,I!', :/fIIO

Your E·Maii AddrllSS: l"f\<l5G!so'"oV""@s:.o-b<..·'-Q ;1-", l,n,.,el.." ""'O.r S ~jDJ.oo, ( .......

1. Ident:llc:ltion:
Sumamtl: Mos:€"S

2 Name urlller which yoo til. your ",pats (i.o .. tlYlrej: ME\. .... I MO.$ (:5

3, N<me of me fIll'NS orgarnUIO!' by ...1'ich you are empbytid, S",Sc.

4 PrasenlAd(!ress 15 W'I""'E"-li5C1t6. (, .s(.~oo'-K>t.2.,(.14T RoPlo.I3t:Il'..<:.I3l?c ....

"0'1 -ro~ ........ o.Jl:.sSu£l'>, S~ "',Illt'"

5.Phont: 1~1 i~5 .. lt....,S5 fax: en Ill+- $'+0,

a Placaote,rtn: CuRBfIlN ~#'

1.OaJeotBu'\h: 01 'JUNE ,,,to

NOTE: AppllCIlnl$ mUSI bfl age 25·35

10. Do you h,wcMdlen? ". ® How many children?

H VES, MYe)'Ou m1Kle pI"(IVis'O/\ lor suppoct 01 your cl'tlldren during yOUr absance?
Vet No

11. for lema19 apPIicMIS: AIll j'tlU pragnonl? Vel

Th~ FIIHNi.,,;o f1tIr';/S et!flONNt;lDIe ty>1.~.1 eul!Joll D{ /O<1ma,stR '" O/Tle' '0 "'0""
obQ<Jr ~ Y",k ;nd ,., mpcrr 0(1 I'H IICt"r16S ."" ~,"fI$ 01 rile U''''.O<f "Mo".
lWIiJo P~VlCJf!$ "Of .Iilao< /flol ~i I~ ccnsdo,,,,,,,,, 01 appk""IS, Pmgnanl
I".......us/S wi! N f,.qu..lI<I fO PtOflt!B!tlT '11<1" nei<lm IIn<I' m9d/<:ll1 eil,1I "fiite It> IoU .. YO'"

 ,M win ~ ~u/.-ec II> sign, w,/ver flxe/uding ttl. D'9 Hammarsk.joSd SChrJIarsNp FIJOO
from any lIfIalrh 1>' modlc,/slruat.on rh,r m,y occur during me lenn 01 ttle Felluwship.

12. Your employer (same as no. 3 above):

• Name 01 the news organization by which yoo are employed: .s~C (~1'Ib,0")

• Supervisor's Name and Tille: CL ItJi"ON N A c.-oo R

• Supervisor's E·Mall: n0500rc G sc...hc. c..c"l.o.

• Supervisor's Phone/Fax: 011 1 f'+ {,(jOO I ...::01' g 3 11" 5 .,1>.

, 3. Your present positlon/li!1e: S (tJIOQ, F-e:Po ~ n 't. J r- I.e ~ '- J\t..:lU;: /-.lE- NS NJt..·w~

t4. How long have you held your current position? S '1 Lf\R.s

15. How long have you worked for your pi"

16. What is the ownershi

o independent C' p Other (specily), _

17. How frequently IS your pu,ib~1om .,.-'

~aily weekly c monthly 0 Other {specily} _

18.11 you WQrk for a radio or televi$lon station, how frequently does your program air?
£V~o..j 01\"1

19. WhallS the Circulation 01 your publication or audience size 01 your program?
1'\ Ro.D'o STJOmONS --= :!: 11 MILl-IOoJ 1..1 r.:rCJUIOI?-.\;