STUDENT MEDIA ADVISING INTAKE FORM
STUDENT MEDIA ADVISING INTAKE FORM
APPLICANT INFORMATION
Name
Name
*
First
Last
Phone
Phone
*
-
###
-
###
####
Email
*
Address
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
United States
United Kingdom
Canada
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Netherlands
France
Germany
-------
Afghanistan
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Vatican City
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Vietnam
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SCHOOL INFORMATION
School
*
If not currently employed, please enter "NE"
Position
*
Position
Teacher
Adviser
Administrator
Not currently employed
Does your school have any of the following:
Does your school have any of the following:
Newspaper
Journalism program
Both
COURSE EXPECTATIONS
Are you taking this course to satisfy recertification requirements?
*
Are you taking this course to satisfy recertification requirements?
Yes
No
If no, please indicate why you are taking this course:
In general, what do you hope to get out of this course?
*
What specific skills or knowledge do you hope to develop as a result of attending this course?
What barriers do you currently face as a student media professional?
How did you learn of this course?
*
How did you learn of this course?
FIU Website
FSPA Listserv
MDCP Newsletter
Online Search
Word of Mouth
Other
Other
(select all that apply)