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DAG HAMMARSKJOLD, JOURNALISM FEL OWSHIP APPLICATION

Deadline for Submiss'on: AprH 9, 2010'

Yom E-Mail Add ess: _ ¥ . 8 l , ~ ~ C I . c ~ : : L - : ; ~ ' : X l ! l ; j 5 l - . . ! - - - \ . " "   _

1. ldentificatfon:

Sum arne :. Z. \ c:, l- ' \-.

Given or first name(s):

The names should match those on your passport.

-:t. \   \ \ - , \ . . . . ~2. Name under which you file your reports (i"e., byline): \ o . . . ~  3. Name of the news organization by which you are employed: l E ~ t - \     Q..h, \... ~ ' { ; .   ? E - N ~   'r

4. Present Address:

Fax: '.) I)...

8. Citize ship: ' T ~ ,     \)L.   "E. Passport 0.:

9'. Sex: Male \Femame,{

10. Do you have children? No How many ch 'Idren?   ,.:oa.

If YES, have you made provision for support of your chHdren during your absenoe?

( Y e ~ ,   No

1. For female applicants: Are you pregnant? Yes

The Fe/lowshipentails considerable physical exertion by journalists in order to move

about New York and to report on the activities and proceedings at the United Nations.

While pregnancy is not a factor that wfJ! exclude consideration of Bpplicants. pregnant

journalists wf// be required to provide for their health and medical Gare while in New York

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and wi ' 00 r e q u , , ~   10 sign a waiv"r excJudong Ihl' Dag Hammerskjold SChoJarMlip FlIt'td

/rom any /wallll or m6l1icel situarion tn"lm"y 0CCUf durirlg rile lerm of lite FeI/cm$hlp.

12. Your employer (same as 1'10. 3 above):

• Name 01 the news Ofganlzallon by which you ale employed: \.. 0;;;. <!J>o,. w P< o . . t l 1 t - l ~ e { ' l < N t : l ~ , i \  

• Superviso!""s Name and Title: p.., V I 'E. ~ . . . .   ""-\),,,'f,

• Supervisor's E-Mail:  • Address:

14. How long have you held your current position? ~ \ ' <   'E " £1'0. (1..  

15. How fang ha'ye you worked for your present employet?   \ '\("t.- 'J"E. '" (l,.  

16. What is !he ownership of your publicatiOn or Slatkin?

) I l 1000ependet1t IJ private :.J government-owned u Other (spoeofy) _

17. How frequently IS your publication issued?

.J dally   weekly 0 monthly Other ($p8(:ify) _

18.11 you work,or II radiO or television stalioro. how frequently does Y'JUr program air?

19. What is the circulation 01 your publication Of audience size 01 your program?

5\l<:l .(f)<::J20. Describe your current job and responsibilijles (continue on separate sheet If

necessary),

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