National People of Color Media Institute Application Form

Please complete the following application if you are interested in participating in the 2012 GLAAD National People of Color Media Institute.

Many questions are optional, however it’s important for us to have this information in order to put forward spokespeople who meet the needs of media outlets while accurately reflecting all the voices of our community. We will certainly contact and inform you about specific media requests before releasing your information to the press, and you are under no obligation to do any interview. We also hope to use this information to identify people for workshops, trainings, and news updates.

Example: she/her









LGBT or otherwise



Files must be less than 800 KB.
Allowed file types: txt rtf html odf pdf doc docx ppt pptx xls xlsx xml.
In 500 words, please state how your participation will advance your advocacy goals.

Above, outline the amount of time you are able to commit to the institute program and be available for media interviews if needed (once per month, 4 hours per month, available any time, etc.)