Request edit access
MDIF Myanmar Media Program Application
Online Application Form for Media Organisations Interested in Participating in the MMP.
1. Media Name *
Your answer
2. Type of Organisation (Choose One Only) *
Required
3. Please list the names of the directors of your organisation. *
Your answer
4. If your organisation is a private company, please list the principal shareholders of your company.
Your answer
5. Name of Participating Media Executive *
Your answer
6a. Media Executive Contact Details: Email *
Your answer
6b. Media Executive Contact Details: Mobile Number *
Your answer
7. Media Office Address: *
Your answer
8a. Media Organisation's Web Address (if applicable). Answer must begin http://
Your answer
8b. Media Organisation's Facebook Page Location (if applicable). Answer must begin with http://
Your answer
9. When was your media organisation founded? Month and Year. *
Your answer
10. What are your personal goals for participating in MDIF's Myanmar Media Program (250 words or less) *
Your answer
11. How would you define your media's primary audience? (Choose one only) *
Required
12. Please indicate all of the media types that you produce to reach your monthly audience? (Choose all that apply) *
Required
13. Please choose the one media that is most important to reaching your monthly audience? (Choose one only) *
Required
14. During the past 12 months, what was your media's average monthly audience for your primary media type selected in Question 13 above? For online media, do not include your social media/Facebook reach (Choose one only) *
Required
15. Please indicate your media organisation's annual expense budget for the most recent year. (Choose one only) *
Required
16a. Please rank the following revenue types based on their relative importance to your organisation's income. *
Not Important
Somewhat Important
Very Important
Extremely Important
Grants
Individual Donations
Subscriptions/Sales
Advertising
Syndication
Other
16b. If you ranked "Other" in question 16a as either "Very Important" or "Extremely Important", please describe the "other" revenue type.
Your answer
17. Please describe the major goals you would like your media organisation to achieve by December 2018. (250 words or less) *
Your answer
18. Other than financial resources and government policy, what do you see as the major challenges to achieving these goals? (250 words or less) *
Your answer
19. Over the past 12 months, please choose one piece of reporting (in any language) from your media and describe its importance to your audience. (250 words or less) *
Your answer
20. If available, please provide an online link to the story, video or audio program described in question 19. Answer must begin http://
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service