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DAG HAMMARSKJOLD JOURNALISM FELLOWSHIP APPLICATION

Oeacll . . . lo r SubmJ..., . ,: April ' , 201 a

Your EMal Address: d d c " j " 5 C C l P @ c . o r C U I Q '.0,.., pc:

1. Identification: 5 ,Surname: ' 1 )00"50 Sa"'-l n Q . 0

GivlIn 0 ' first nllme(,): ~ b c " Q .

The name, shoUld match those on your passport.

2. Name under which you file your rllPO'ls (i,e .. byline): 'l)oi"bo,o. "tIor>30' 5 0 " 0 5

3. Name ollhe news organization by wtlich you are errpIoyed: El Co" ,e ..c.,Q

4. Present Addres:s: 'Oolbc>o :31,;! SOr> I!)lC\r"O, L ' ..... C\ .::11, 'Pcr";

e. Place 01 BIM: l..l mOl, 'Po:: .. ...:

7, Date of Birth: O c t o b e r 15t , Iq" , /NOTE: AwIieants must be age 25-35

8.Citizenmip: ' h n .... , a n

9. Sex: Male

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and will be reqUired 10 "!1" a waiver ellctuchng rJNI De g HlJlTlmars/t.jok1SchoIafshJp Fundfrom any IMJII/lh Of mtKiictII S#UafJon ther ma y 0CCIJf dun"9 th6 term of tile FeUows/lJp

12. Your employer (same as no. 3 above): Name 01 the news organilation by which you are employed: EJ C c ........~ r c ' o

&pervisor's Name and TIlle: ,f...,oro ' l b r e d < : ' . ~ C o ~ t r - o , Ed,to..-' ' ' ' ' c h ' ~ F

Supervisor's E-Mail: j p ~ r e c l e ' ; ; ~ c o ......e..-c'o c.c"" r=

) 1 fo . ' t d ~ o f l l O Supervisor's PhoneIFax: ( !h l ) :)\1 C;:-. , 0 ( E" t . nun,be..- S 8 d l ~

_ .. LJ a e "Per .... Address: ::;,("0"" .....n t o n ' o i"'\,("o O v C ~ d o . .... 0 , t r > ,13. Your present positionllitle: 'Il.epo.-ttl'"

14. How long have you held your current position? 3 ,!;leo...- 5

15. How long have you worked for your present employer? J ~ C ' : o " 5

16. What is the ownership of your publication or station?o independent r.ii; private 0 government-owned 0 Other (specify) _

11. How trequently is your publication issued?)i daily weekly 0 monthly 0 Other (specify) _

18. II you work lo r a radio or television station, how frequently does your program air?

19. What is the CirCulation 01 your publication or audience sile of your program?" r o .. " d 6 0 0 t . h c " ' ~ o . . d d o . , l j

20. OeSCfibe your current job and responsibilrties (continue on separate sheet ifnacessary).

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