Media Mentor Application
YES! I want to serve as a JRNOLA media mentor. Please contact me with more information on how I can be involved!
I would best describe my professional media experience as:
On Air Talent
Digital / Social Media
General Volunteer: Non Media
Current or Past Employer(s) or Media Outlets
Best Contact Phone number
Particular coverage areas of interest
Music and entertainment
Arts and culture
Politics and government
Civil rights and social justice
Ways you can help
Remote or in-newsroom editing
Have you ever been charged with, convicted of, or pled guilty to any crime? *If so please describe.
Are you willing to submit to a background check as a condition of volunteering? If yes, you give permission for JRNOLA to conduct background checks on you, which may include (but are not necessarily limited to) reviews of sex offender registries, child abuse and criminal history records). I understand that false or misleading information on this application, or the discovery of inappropriate information through my background checks, may result in JRNOLA declining my mentorship application (or the termination of my mentorship position if already accepted). I hereby release and agree to hold harmless from liability to JRNOLA, the employees and volunteers thereof, or any person that may provide such information. In submitting this form I agree to my details being used for the general purpose of fulfilling my request to mentor, donate or receive an e-mail newsletter. The information will only be accessed by JRNOLA staff. I understand my data will not be distributed to third parties. I have a right to change or access my information. If you have any questions about our data security or data retention practices, please email us at
. I also understand that, regardless of previous appointments, JRNOLA is not obligated to appoint me to a mentorship position. If appointed, I understand that, prior to the expiration of my term, I am subject to suspension by the Staff and Board of Directors of JRNOLA for violation of JRNOLA policies. Note: JRNOLA will not discriminate against any person based on the basis of race, creed, color, national origin, marital status, gender orientation, or disability.
YES, I agree
NO, I do NOT agree
For the background check, please upload a .pdf of your driver's license.
Anything else we should know about you?
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service