Media Request Form

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Media Request Form

Please fill out this form to request an interview or meeting with Dr. Kisha Supernant, IPIA Director

Email *

First and Last Name *

Affiliated Media Outlet *

Phone Number *

Media Format *

Radio Interview

Television Interview

Print Article

I would like a meeting to gather information only

Other:

Required

Summary of Proposed Topics / Content *

Will the interview be pre-recorded or live? *

Pre-Recorded

Live

Not Applicable

Interview or Meeting Format *

Phone

Zoom

Skype

Other:

Preferred Timeline

This week

Next week

This Month

Other:

Clear selection

Approximate Length

15 minutes

30 minutes

1 hour

Other:

Clear selection

Notice

Please note that we may not always be able to accomodate short notice for media requests, but will always try to respond in a timely manner. In the case where Dr. Supernant is unavailable for your media request, we may be able to recommend someone else for your interview.

Send me a copy of my responses.

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