Southeast Asia Technical Assistance Initiative (SEATAI)

Email address *

1. Media name *

2. Type of Organization (Choose one only) *

Non-Governmental Organization (NGO)/Non-Profit

Private Company

3. Please list the names of the directors of your organization. *

4. If your organization is a private company, please list the principal shareholders of your company. *

5. Names of two media executives in your organization who would lead participation in SEATAI *

6. Please provide the two media executives' contact details

6a. Media Executive 1: Email *

6b. Media Executive 1: Phone number *

6c. Media Executive 2: Email *

6d. Media Executive 2: Phone number *

6e. What is the name and position of the person in your organization who is responsible for revenue generation? *

7. Address *

8a. Media Organization's Web Address (if applicable)

8b. Media Organization's Facebook Page Location (if applicable)

8c. Media Organization's Instagram Page Location (if applicable)

8d. Media Organization's Twitter handle (if applicable)

9. When was your media organization founded? Month and Year. *

10.a How many staff do you have? *

10.b Of them, how many work full time? *

11. What are your goals for participating in MDIF's Southeast Asia Technical Assistance Initiative? (250 words or less) *

11. How would you define your media's primary audience? (Choose one only) *

National - Relevant to people living in all parts the country where the media is located

Local - Relevant to people living in specific cities or regions of the country where the media is located

Regional - Relevant to people living in one or more countries in Southeast Asia

International - Relevant to people living in one or more countries in and beyond Southeast Asia

OtherOther

13. Please indicate all of the platforms that you use to reach your audience? (Choose all that apply) *

14. Please choose the media platform that is most important to reaching your audience? (Choose one only) *

15. During the past 12 months, what was your media's average monthly audience for your primary media type selected in Question 14 above? (Choose one only) *

16. Please indicate your media organization's annual expense budget for the most recent year. (Choose one only) *

17. Please indicate what percentage of your income comes from the following sources:

17b. Individual Donations (from founders, friends and family, audience members) *

17g. If you ranked "Other" in question 17f as more than 50%, please describe the "other" revenue type.

17. Please describe the major goals you would like your media organization to achieve by December 2022. (250 words or less) *

18. Other than financial resources and government policy, what do you see as the major challenges to achieving these goals? (250 words or less) *

19. Over the past 12 months, please choose one piece of reporting (in any language) from your media and describe its importance to your audience. (250 words or less) *

20. If available, please provide an online link to the story, video or audio program described in question 19. Answer must begin http://