Professional Documents
Culture Documents
1. APPLICANT DETAILS
*Name:
TITLE
*Media Type
FIRST NAME
Radio
LAST NAME
Television
SUFFIX
Online
(primary)
*Address
STREET ADDRESS
ADDRESS LINE 2
SUBURB
STATE
POSTCODE
*Email Address
*Phone Number
MOBILE
Website
LANDLINE
Media Outlet
Freelancer
(proceed to"Community
Details" section)
Outlet Name
(If not a freelancer)
Outlet Address
STREET ADDRESS
ADDRESS LINE 2
SUBURB
STATE
POSTCODE
Name of Editor /
Producer /
Chief of Staff
Editor / Producer
/ Chief of Staff's
Email Address
Editor / Producer
/ Chief of Staff's
Phone Number
Media Outlet's
Website
MOBILE
LANDLINE
3. COMMUNITY DETAILS
*Language of
publication
(please specify)
*Community
(select one)
Afghani
African
Arabic
Armenian
Bangladesh
Bengali
Bosnian
Cambodian
Chinese
Croatian
Czechoslovakian
Dutch
Estonian
Fiji
Filipino
Finnish
French
German
Greek
Hungarian
Indian
Indigenous
Indonesian
Iranian
Other: ______________________________________
Irish
Italian
Japanese
Jewish
Korean
Laotian
Latino
Macedonian
Maltese
Nepali
New Zealand
Pakistani
Polish
Portuguese
Russian
Serbian
Spanish
Sri Lankan
Sudanese
Thai
Turkish
Ukrainian
Urdu
(please specify)
*Background /
Precis of Entry
(Max. 1,500 words Attach on a separate
piece of paper if more
space if required)
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*Entry Medium
*Language
of Entry
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Yes
No
(please name all
contributors and their
roles e.g. "camera
person")
Audio
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Video Online
5. AWARD CATEGORIES
*Which category
are you
entering?
(NB: complete one form per entry per entry, per award category entered)
Please read the selection criteria in the Media Awards Guide to make sure
that you have submitted any additional requirements of each category.
Download a copy here: http://bit.ly/mmguide2012
s.moselmane@parliament.nsw.gov.au