Medical Evidence 2012 Application Form

Boot Camp

Application deadline: September 14, 2012. We are no longer accepting applications for this Boot Camp. The judges will make their selections by mid-October. All applicants will be notified by then via e-mail.

The first step of applying to the Boot Camp is to fill out the form below. If you prefer not to use the online form, you may request a PDF application by contacting knight-info@mit.edu.

After completing this form, you must submit the additional materials listed on the Boot Camp / Workshop Application Instructions page.

About you

First Name: *

Last Name: *

Date of Birth: *

Citizenship: *

U.S.

Other

(if other, please specify)

Employment information

Current Job Title: *

Employer: *

(publication or program)

What year did you become a journalist?: * (YYYY)

Do you already cover science, health, environment or technology?: *

Yes

If you answered "no," be sure to address your interest in pursuing science journalism in one of your supplementary essays.

Contact information

Email: *

Work contact information

Street Address: *

Address Line 2:

City: *

State/Province: *

(If none, enter "None")

Postal Code: *

(If none, enter "None")

Country: *

Home Contact Information

Street Address: *

Address Line 2:

City: *

State/Province: *

(If none, enter "None")

Postal Code: *

(If none, enter "None")

Country: *

Home Phone: *

Mobile Phone:

Two letters of recommendation

As part of your application materials, we ask for two letters of recommendation from individuals familiar with your work. Please list the people you've asked to send letters:

Name (1): *

Name (2): *

Employer's letter

We ask non-freelancers for a letter of support from a supervisor. Please tell us your supervisor's name. (Freelancers, type "freelance.")

Name: *

Previous fellowships, scholarships or awards

Please list any awards or fellowships you've received.

How did you learn about this boot camp?:

(Please check all that apply)

Other (Please specify):

Knight Science Journalism at MIT