Student Journalism Application

General Information

First Name*

Last Name*

Birth Date*

Email*

Phone (cell)*

Phone (home or other)

Address*

Street Address Address Line 2 City State ZIP Code

What is your preferred method of contact?*

School Name*

Year In School*

Why would you like to become a student journalist?*

Name of Contact*

Relationship to You*

Primary Phone*

Emergency Contact Address*

Street Address Address Line 2 City State ZIP Code

Gender

What is your race?

How did you hear about the program?