Journalist Interview Questionnaire
Please fill out the questionnaire to assist in the interview process.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Organization/Outlet
*
Interview Topic/Subject
*
Key Questions or Topics of Interest
*
Preferred Interview Date and Time
Interview Location or Method (In-person, Phone, Video)
Interviewer Name and Contact
Additional Notes or Requests
Consent to Use Interview Content
*
1
I agree to have the interview content used for publication and media purposes
Submit
Should be Empty: