Peter M Acland Foundation-Fellowship Application Form

Peter M Acland Foundation
2018 Journalism Fellowship
Application Form

Peter M Acland Foundation
2018 Journalism Fellowship
Application Form
Application Deadline 28 October 2017

Personal Information

* Indicates required field

First Name Last Name *

First

Last

Address *

Contact Phone Number +6427 ### #### *

Email *

Date of Birth - ##day/##month/####year *

Current Employment *

Current Position *

Please upload a current headshot Photo *

Max file size: 20MB

Employment Experience
Begin with present position

Current Employer or Free Lance *

Position and Duties-Current Employer or Free Lance *

Dates Employed - From - Until *

Previous Employer 1 *

Position and Duties-Employer 1 *

Dates Employed - From - Until *

Previous Employer 2 *

Position and Duties-Employer 2 *

Dates Employed - From - Until *

Previous Employer 3 *

Position and Duties-Employer 3 *

Dates Employed - From - Until *

Education and CV

Schooling *

List tertiary education - Institution, qualifications or experience *

Attach Current CV *

Max file size: 20MB

International Experience

Attach Brief Description of Any Overseas Work or Travel *

Max file size: 20MB

Examples of Work and Letter Detailing Why You Should Be Selected

First Work Example *

Max file size: 20MB

Second Work Example *

Max file size: 20MB

Third Work Example *

Max file size: 20MB

Letter Detailing Why You Should Be Selected *

Max file size: 20MB

Fellowship Matters to be Arranged by Applicant

Details of Organisation Applicant will Arrange to Work At and Proposed Dates *

Attach Letter of Support from Overseas Organisation *

Max file size: 20MB

Attach Letter of Support from Current Employer if not Free Lance *

Max file size: 20MB

If Free Lance Attach First Reference *

Max file size: 20MB

If Free Lance Attach Second Reference *

Max file size: 20MB

If Free Lance Attach Third Reference *

Max file size: 20MB

Attach Applicant Budget to undertake PMAF 2018 Fellowship *

Max file size: 20MB

Agreement to Fellowship Conditions

The above named Applicant declares that all information given in support of this application is true and correct and confirms that the Applicant has read the conditions regarding the Fellowship on the Peter M Acland Foundation (PMAF) website.

The Applicant agrees by submitting this application and if awarded the 2018 PMAF Fellowship that:

All personal information supplied by the Applicant to the PMAF may be disclosed to the trustees of the PMAF, such of the PMAF's advisers and staff who administer the PMAF and to the members of the PMAF Judge's panel.
The budget presented to the judges will cover the recipient's salary whilst overseas, and the travel and accommodation costs for the agreed period;
The recipient will work for the nominated period with the nominated media organisation;
The recipient's details and information about the awarding of the PMAF Fellowship may be distributed to the media and for promotional purposes;
The recipient will provide a written report to PMAF within three months of the conclusion of the work period reflecting on the recipient's experience and how the knowledge and skills acquired whilst on the Fellowship will be shared by the recipient with colleagues and the wider journalism industry.

Declared and Signed by Applicant on [Date] *

Submit PMAF Application