Mosaic 2019 Summer Journalism Workshop

June 10 - 21

Student application

Name: ____________________________________________________________________

Birthdate: ______________________________

Email: _________________________________ Student cell phone: ___________________

Parent name(s): ____________________________________________________________

Parent phone: _____________________ Parent email: _____________________________

Home address: Street: _______________________________________________________

City, State ZipCode: _________________________________________________________

School: __________________________________________ Current grade level: ________

Gender: ___________ Ethnicity: _______________________________________________

1) In 100-300 words, please explain why you are interested in participating in Mosaic (attach
additional sheet if needed). Are you interested mainly in reporting or photography?

2) Does your school offer (circle all that apply)

Journalism class Photography class

Journalism club Multimedia class
Video class Web design class
Yearbook class Other media (explain)

3) Which of the above classes have you participated in? (experience is not necessary)
4) What are your interests? (circle all that apply)

Writing Making a difference in my community

Reporting Learning about particular issues
Audio/Video Meeting new people
Reporting Having my views represented in the media
Web design and management Learning other skills (list):
Photography

5) Please describe three stories or photo/video essays you would like to produce, or issues you
would like to explore. Please be as specific as possible. Why are you interested in these
subjects? Attach a separate sheet if needed.

6) What are your current educational or career goals?

7) Is there anything that we need to consider to enable you to participate? Other commitments
such as job or family obligations, or transportation needs?

8) Please send a sample of your work — a news story if you’ve taken journalism, a class
assignment or personal or independent writing, or photographs (digital file is fine). Attach the
work if you are emailing this application. Or, if you’re applying online, please email your work
separately to snoguchinews@gmail.com. Write “Sample work for Mosaic application” in the
subject line of the email. Please check here that you’ve emailed your sample work: _______

9) Please list someone at your school who could provide a reference for you.

Name___________________________ Email____________________ Phone___________

10) Other comments or ideas?

Scan and email this application to ​snoguchinews@gmail.com​ by Monday, March 4.

Please write “Mosaic application” in the subject line.