Form
The fellowship aims to support journalists and media makers from crisis and conflict contexts to continue providing critical information. The fellowship is financed by the German Foreign Office and implemented by Media in Cooperation and Transition (MiCT) in collaboration with its international partners. Selected Fellows may received individualised support depending on their needs. For more information visit https://fellowship.mict-international.org/
To apply - we just need a bit more information about you - but don’t worry, it won’t take long. The information will of course be confidential and shared with the MiCT Fellowship team and selected, trusted, independent jury members only. In case you feel more comfortable applying for the fellowship via a secure channel, please write us an email at: contactmict@protonmail.com
Back
Next
0 - Date
-
Day
-
Month
Year
Date
1 - Name
*
First Name
Last Name
2 - If non latin alphabet: please state the latin language spelling of your name as per passport
3 - Date of birth
*
-
Month
-
Day
Year
Date
4 - Gender
*
Please Select
1-Male
2-Female
3-Other
5 - Email
*
example@example.com
6 - Phone (WhatsApp/Signal/Telegram):
*
-
Area Code
Phone Number
7 - What is your preferred contact method?
*
Please Select
Email
Whatsapp
Telegram
Signal
Back
Next
8 - What citizenship(s) do you hold?
*
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
9 - What other citizenship(s) do you hold?
Please only reply if you have a secondary citizenship
10 - Where do you live currently (city)?
*
11 - Do you consider yourself to be living in exile?
*
12 - What's your current legal status where you live?
*
Back
Next
13 - When did you last publish journalistic work?
*
Please Select
1- In the last week
2- In the last month
3- In the last 6 months
4- 7-12 months ago
5- Over a year ago
14 - if over a year: Please elaborate what has prevented you from publishing recently?
*
15 - CV Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
16 - Can you send us links to three publications that best represent your work? Please post the first link here.
*
17 - Can you send us links to three publications that best represent your work? Please post the second link here.
18 - Can you send us links to three publications that best represent your work? Please post the third link here.
19 - Who can verify your media profession? Please add references with names and contact information (max. 2 references)
*
Please indicate "Name, Position and contact information"
20 - Have you applied for and/or received support from other organisations in the last 6 months?
*
Please Select
1- Yes, received
2- Yes, applied but not yet received
3- Yes, applied but rejected
4- No
5- Other
21 - If yes: Please elaborate. What organisation and what support did or do they provide to you?
*
22 - If other: Please elaborate. What organisation and what support did or do they provide to you?
23 - Link to your Social Media profile:
Please choose only your most relevant profile
Back
Next
24 - Please outline the risk /threat you are facing in as much detail as possible
*
25 - Please attach relevant proof documents of your risk
Browse Files
Drag and drop files here
Choose a file
(please combine into one pdf)
Cancel
of
Back
Next
26 - Is there anything else we should consider?
Submit
Should be Empty: