Country of residence
What region/country do you report from/on (you can state several)?
Language you'd like to be mentored in
What is your beat or area of expertise? e.g: health, business, culture, foreign correspondence
What is your medium for journalism (print, video, radio etc.)?
Have you faced significant stress while on the job?
Rather not state
If YES to previous question, was the stress related to any of the following?
What stage of your career are you in?
1 to 3 Years
3 to 5 Years
5 to 10 Years
10 to 20 Years
Are you on staff journalist or independent/freelance. (Please name the outlet/s)
Are you looking for long- or short-term mentorship?
Longterm (three months or more)
Short-term (three to four weeks)
Situational (relative to the task at hand)
What kind of mentorship are you looking for?
Navigating a story/country
Mind block/Brain enhancement
Stress, trauma or PTSD
How can we reach you? Please provide multiple options if possible: email address, phone number, Skype handle, etc.
Please list the best dates with two time slots each on EST, to reach you:
Are you able to pay the minimum of $30 processing fee? (Once your mentor is assigned, you will be directed about how to pay.)
A copy of your responses will be emailed to the address you provided.
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