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High School Workshop Application
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Are you a student member of NABJ? Yes
First Name:
Last Name:
Email Address:
Home Phone:
Cell Phone:
Date of Birth:
High School:
Year in School: Freshman
GPA: Please indicate if using 4.0 or 5.0 scale (i.e. 3.6/5.0)
High School Street Address:
High School City:
High School State:
High School Zip:
Home Street Address:
Home City:
Home State:
Home Zip:
Name of Parent or Legal Guardian:
Parent or Legal Guardian Phone Number:
Parent or Legal Guardian Email Address:
Do you have any journalism experience? YES
If yes, what kind of journalism experience do you have? Please check all that apply. Internship with local media outlet
Internship with national media outlet
Participant in a journalism workshop
High School Newspaper, TV, or radio program
High School Yearbook Staff
High School Journalism Classes
Personal Weblog
Personal Podcast or Video Podcast
Please describe your duties and experience in the above-mentioned activities.
Please provide three references: one academic, one professional, and one personal. For each reference, please include the following: name, title, affliliation to student (no family members, please), phone number, and e-mail address.
Why do you want to attend this workshop?
If selected to attend, what do you hope to gain from this experience?
What else should we know about you?
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