Chapultepec Scholarship-IAPA/Knight-WallaceFellows

attheUniversityofMichigan

DEADLINEFORAPPLICATIONS:FEBRUARY25/2015

Submitonecopyofallapplicationmaterials.

Fillinelectronicallybeforeprinting.Completeallitems.

Refertowebsiteforfurtherinformation.

Informationwillbeusedonlytoevaluateapplicantsandwillbekeptconfidential.

Donotfold,stapleorbindmaterials.

l.Name 2.JobTitle_____

3.Employer

ParentCompany __

4.SupervisorTelephone Email

5.Preferredmailingaddress:(checkone)

Office0Home 0

6.OfficeAddress

7.HomeAddress

8.Telephone:Office:_

Home:_____Cell:

Fax:

9.Email

10.Female 0Male0

11.DateofBirth___

12.CityandCountryof Birth ------

13.Citizenship__

14.Race/Ethnicity(Optional):

0Black/AfricanAmerican0Hispanic/Latino American0White/Caucasian0AsianAmerican 0American Indian 0 Other(Pleasespecify)

15.Education:

SchoolNameDatesDegree(s)

Undergraduate- / ------/ ----- / ­
Graduate--- / ------/ ----- / -

16.ForeignLanguageProficiency------

17.Majorjournalismprizesand/orawards:

AwardNameYear

18.ScholarshipsorFellowshipsreceived:

NameYear

19.HaveyouappliedforaKnight-WallaceFellowshipinthepast?Yes 0No 0

20.Numberofyearsofprofessionaljournalismexperience__

21.Onaseparatesheetlistlistpositionsheldsincecompletingformaleducation, beginningwithcurrentemploymentandinthefollowingorder:

•Employer

•Dates

•Title

•ImmediateSupervisor

•AnnualSalary

Inadditiontoprovidingtheinformationabove,pleasesubmityourresume.

22.Provideanautobiographyofupto1.500words.Examinetheintellectualandsocialvaluesthat shapeyourwork asajournalist.Exploretheoriginsofthesevaluesandexplainhowtheycontributeorrelatetosatisfactionderivedfromjournalism.

23.Provideaprojectedstudy planof upto500words. Inwhatacademicareasdoyouproposetowork?Howdotheserelatetoyourcareerobjectives?Howdoyouplantocarry outthiswork:Courses?Tutorials?Research?Indicateareasofstudy,notspecificclasses.Inthespacebelow,provideasummaryofyourstudyplanintenwordsorless:

24.Provideexamplesofyourprofessionalwork. Noentrymaterialswill bereturned.Donotusescrapbooks,presentationfoldersorstaples

ProvideonecopyofeachsampleandEnglishtranslations.

25.Fourlettersofreferencearerequired:

Lettersshouldbesentdirectlyfromtheletterwriterinonlyoneofthefollowingforms:email,faxormail.

AlllettersshouldbewritteninEnglishorbeaccompaniedbyanEnglishtranslation.

l.Oneprofessionalletterofreference:

NameAffiliation

2. Onepersonalletterofreference:

NameAffiliation

3.Letterfromyourimmediatesupervisor(ifapplicable)elucidatingyourqualificationsforaKnight­WallaceFellowship:

NameTitle

4. Aletterfromyouremployersupportingyourapplicationandgrantingyoualeavefortheacademicyearifyoushouldbeofferedafellowship.Ifyouareunabletoobtainthisletter,pleaseexplainwhyinthespacebelowandsendanadditionalletterofreferenceinstead:

NameTitle

26.DisciplinaryHistory/ConductCode

Haveyoueverbeenexpelled,suspended,orplacedonprobation byanysecondaryschoolorcollegeyouhaveattended,farreasonofacademicdishonestyorbecauseofanoffensethatharmedorhadthepotentialtoharmothers? Yes No

Haveyoueverbeenconvictedofacriminaloffenseotherthanaminortrafficviolation,oraretheresuchchargescurrentlypendingagainstyou?YesNo

27.Icertifythatalltheinformationprovided hereistrueandcomplete.

Date

HowdidyoulearnoftheKnight-WallaceFellowship?Checkallthatapply:

0ReceivedIAPAe-mail0Webadvertisement 0 Internetsearch

0Knight-WallaceAlumni0Friend/employer

0Advertisementinjournalismmagazine0Advertisementinconventionprogram0Conventionpanel/speaker

0Brochure

0OtherPleasespecify

Sendapplicationandmaterialsto:

Interamerican Press Association Jules Dubois Building

1801 SW 3rd Avenue, Suite 800

Miami, FL 33129, USA

phone:305- 634-2465fax:305-860.4264

.