THE HANSEL MEDIA

ONLINE MEDIA PARTICIPATION FOR CHANGE AWARD

2015

APPLICATION DEADLINE: SATURDAY 30 MAY 2015

PERSONAL DETAILS
NAMES (Full names)
UB Registration Number

Level
Date and Place of

Gender

Birth

Nationality

NIC Number

CONTACT DETAILS
Residential address

Postal address

Cell phone

Landline

E-mail address
Please list the online platforms, titles and links of your online activities. An example has been provided for you.
1 Online

Blog

Title / Topic

Hansel Media / Online Promotion

Link

platform
2

Online

Title / Topic

Link

Title / Topic

Link

platform
3 Online
platform

Please write your personal and professional profile, max 300 words.

www.hanselmedia.blogspot.com

MOTIVATION
Why do you consider yourself to be an instrument of change in your community?

What are your expectations of this award and how it will benefit you personally and professionally?

I hereby certify that the information provided in this contract is accurate and complete in all respects, and that I agree to be
bound by them.

___________________________________________
Signature of Applicant (write your full name)

___________________________________________
Date of signature

Kindly scan and email back to the Mr. Morku Lesley, ompcaward@hanselmedia.com