Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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Media Outlet
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Name of Supervisor
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Is this a class assignment?
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Yes
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In which format will the story be published?
Print
Radio
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Requesting
Please Select
Staff Interview
Media Elements
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DEADLINE: Last possible date and time for an interview
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-
Day
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Date
Example: 1:50 PM
AM
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AM/PM Option
Preferred Interview Platform
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In-person / On-camera
Email
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Secondary Preference
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Please Select
In-person / On-camera
Email
Phone
No Preference
Availability (For in-person interviews only)
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Morning (between 8 a.m. and 12 p.m.)
Afternoon (between 12 a.m. and 5 p.m.)
No preference
Please specify the topic covered in the interview and provide a list of potential questions you would like answered.
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Potential air or publish date
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Day
Year
Comments
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