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APPLICATION FORM

Investigative Reporting Seminar: Transparency, Accountability, and the 2016 Elections

A four-day training seminar-workshop of the Philippine Center for Investigative Journalism


A. PERSONAL DETAILS
Full name:
Nickname:

Gender:

Date of Birth (day/month/year)

Landline:

Mobile number/s:

Email Address:

Mailing Address:
Professional or Civic Affiliations:

B. YOUR WORK
B.1. For journalists
Primary Media Agency:
Affiliation of Media Agency (PPI, KBP, NPC,
etc.):

Position:

Platform (please check):


Print
TV
Radio
Online

Your Position or Designation:


Brief description of your role and work

Number of years employed with media agency: Previous positions held at this media agency:
Name of Editor/Supervisor:

Designation:

Landline:

Mobile number:

Email address:

Mailing Address:

Other Media Outlets (current):

Your functions/tasks in the agencies:

Total number of years practicing as journalist:

B.2. For citizen media and bloggers


Title of blog/website:

URL:

Date when blog/website was founded:


Mainstream media outlets to which
you contribute, if any:

Number of years as contributor at media outlet:

Other websites to which you


contribute:

URL

Number of years as
contributor at website:

Total number of years as citizen media or blogger:


C. PREVIOUS WORK EXPERIENCE
Start with your most recent engagement. Use a separate sheet if necessary.
Agency/Organization
Designation
Inclusive Dates

D. STATEMENT OF MOTIVATION
Briefly explain why you want to participate in this seminar, what you hope to get out of it,
and how you intend to apply the skills and lessons you will learn. Use a separate sheet if
necessary.

E. PRELIMINARY RESEARCH

Please answer the three questions by filling out the box below. It is important that you
provide data to support your answers. See example.
1. When he ran in 2013, what were the campaign promises that your governor/mayor made as
a candidate?
2. Is he failing or passing in fulfilling those promises?
3. Please provide evidence/data to support your answer.
NAME OF GOVERNOR OR MAYOR: __________________________
MUNICIPALITY/CITY/PROVINCE: ____________________________
Campaign Promises
Made in 2013
1. Improve the health
condition of children in the
municipality

Failing or Passing?
Passing

Because (provide data)


Data from the municipal
health office show that:
the number of children
who received the full
range of DOHrecommended
infant/childhood vaccines
increased from 54% to
70% from 2013-2014 as a
result of the LGUs
intensive immunization
program.
Budget allocation and
spending for health
increased to ___ from
____
Incidence of malnutrition
declined from ___ to
____
Etc.

2. Poverty alleviation

F. PREVIOUS SEMINARS
F.1. Have you participated in previous PCIJ seminars? Yes No
F.2. If yes, please list them below.
PCIJ Seminar Title/Topic

Date

F.3. Please list other journalism and media-related seminars in which you have participated:
Seminar Title/Topic
Organizer/Sponsor
Date

G. REFERENCES
List at least two references with contact details. All fields are required.
G.1. Name:
Agency:
Position:
Landline:
Mobile number:
Email address:
Mailing Address:
G.2. Name:
Agency:
Position:
Landline:
Mobile number:
Email address:
Mailing Address:
H. WORK SAMPLES
Please include one or two samples of your work discussing public policy, development, human
rights, or governance issues.
- For print and online: link to the stories or copies of stories in Word or PDF
- For TV and radio: link to the broadcast story; script or story concept/treatment sent via email as
attachment; recording of TV or radio program/segment may also be sent to PCiJ.

End of Application Form

Successful applicants will be notified within a week after deadline. Only


successful applicants will be contacted by PCIJ.
Completed application forms and work samples must be sent via the following:
By email:
Email address: training@pcij.org
Please state Application to IR Seminar on the subject line
Note: We will acknowledge receipt of all submissions. If you do not receive any reply within
three working days, please resend your application and make a follow up email or call (02) 4346193
By fax:
Telefax: (02) 433-0152
Please write ATTN: PCIJ Training Desk on the fax cover sheet
Note: After faxing, please call (02) 434-6193 to confirm whether all pages had been transmitted
successfully.
By mail:
The Training Desk
Philippine Center for Investigative Journalism
11 Matimtiman Street, Brgy. UP Village Central Quezon City 1101
Note: We will acknowledge receipt of mailed applications via email or text.