High School Diversity Journalism WorkshopJune 22-July 2, 2015 Name (Please print or type) ________________________________________________________Male _______ Female __________

School _________________________________________Current grade in school __________Race/Ethnicity__________________

Home address, including city and zip_______________________________________________________________________________

E-mail ____________________________________________________________________________________________________________

Name of parent(s) or guardian _____________________________________________________________________________________

Home telephone ____________________Parent’s cell or work_________________ Student’s cell___________________________

Journalism experience: Journalism class School newspaper/magazine Yearbook

Photography Layout/design/graphics

Describe briefly the extent of your journalism, publications or other media-related experience:

__________________________________________________________________________________________________________________

List other organizations/ activities in which you participated this year_______________________________________________

__________________________________________________________________________________________________________________

What is your high school grade point average?________________________on a scale of _______________________________

Would you be available 9 a.m. to 4 p.m. during the two weeks of the workshop?_____________________________________

Do you have school/ work obligations that would conflict with the workshop?________________________________________

If selected, do you have daily transportation to downtown Norfolk?__________________________________________________

Where did you hear about the program? ____________________________________________________________________________

Complete this form and a typewritten essay of approximately 250 words stating why you are interested in the workshop and how you would make The Virginian-Pilot a better newspaper. You will also need a letter of recommendation, which should highlight your academic performance and your work as a journalist, if applicable. Letters should not be written by family members or friends.

Send forms to Denise Watson at The Virginian-Pilot,150 W. Brambleton Ave., Norfolk, VA 23510, or fax to 446-2963. For more information, e-mail denise.watson@pilotonline.com or call 446-2504. Deadline is Friday, April 17, 2015.

Finalists will be interviewed by telephone before participants are chosen.

Signature of applicant ___________________________________________

Print name of applicant ___________________________________________

Signature of parent or guardian ___________________________________________

Print name of parent or guardian ___________________________________________