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“Game Changer” Digital Media Fellowship Application
Part I: To be filled out by the Executive Director or Department Head
* Indicates a required field.
Organization Name * Please provide a valid organization name
Executive Director Name * Please provide a valid ED name
Sponsor Name * Please provide a valid sponsor name
Sponsor Title
Address * Please provide a valid address
City * Please provide a valid city
State *
Zip * Please provide a valid zip code to fit this pattern: #####
Phone * Please provide a valid phone number to fit this pattern: ###-###-####
Email * Please provide a valid email address
I hereby submit the name of * as a nominee to 2025BMB's Media Fellowship Program. I agree to work with the nominee to participate and will work with the nominee to develop effective media for our organization. I also agree to attend occasional planning sessions and screenings. Please provide a valid candidate name
Part II: To be filled out by Applicant
Address * Please provide a valid address
City * Please provide a valid city
State *
Zip * Please provide a valid zip code to fit this pattern: #####
Preferred Phone * Please provide a valid phone number to fit this pattern: ###-###-####
Preferred Email * Please provide a valid email address
*Please BRIEFLY (1-2 paragraphs each) answer the following questions:
  Please detail your prior experience with producing videos, writing, or work in the media. Please answer this question.
 
  Describe your position in your organization and/or your career goals. Please answer this question.
 
  Describe the responsible role of media in portraying stories about males of African descent. Please answer this question.
 
  What stories you would like to tell about Black men that are not covered by mainstream media? Please answer this question.
 
  What unique vision would you bring to The 2025 Campaign for Black Men and Boys’? Please answer this question.
 
  Click the star to activate submit button.

Questions? Contact: Cheo Tyehimba Taylor, Natʼl Media Director, 2025 Campaign for Black Men and Boys; 510-823-8150 Email: cheo@forwardevermedia.com

APPLICATION DEADLINE: FEBRUARY 14, 2011
Candidates will be called for pre-interviews before final selections are made.