International Consortium of Investigative Journalists

Awards Application

FULL NAME OF REPORTER(S):
POSTAL ADDRESS:

E-MAIL ADDRESS:
WORK AND HOME TELEPHONE:

COMPANY CONTACT, E-MAIL AND TELEPHONE (IF APPLICABLE):

EMPLOYER (IF FREELANCER, PLEASE STATE):
ADDRESS OF EMPLOYER:
HOW DID YOU HEAR ABOUT THE AWARD:

TITLE OF ENTRY:
DESCRIPTION OF ENTRY:
COUNTRIES IN WHICH REPORTING WAS DONE (THE REPORTER PHYSICALLY TRAVELED THERE):

MEDIUM:
WHERE/WHEN WORK WAS FIRST PUBLISHED OR BROADCAST:
SIGNATURE OF APPLICANT(S) AUTHORIZING PERMISSION TO REPRINT WORK (REQUIRED):

DATE:

Six copies of the published or broadcast entry, the submission letter, and curriculum vitae must accompany this application. Submit to:

ICIJ @ THE CENTER FOR PUBLIC INTEGRITY
910 17TH STREET NW, 7TH FLOOR
WASHINGTON, DC 20006, USA

TEL: 202-466-1300 FAX: 202-466-1101
E-MAIL: mwalker@icij.org
WEB: http://www.publicintegrity.org/investigations/icij/