July 14-17, 2026 Application Form Medicine In the MediaNew York University Wagner School of Public Service105 E 17th StNew York, NY 10003 Name(Required) First Last Email(Required) PhoneWhat state do you live in?(Required) AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State What is your main occupation?(Required) Full time staff journalist at news publication/outlet Freelance journalist Not traditional journalist (eg blogger) Press Officer Editor Journalism student or intern Other OtherPrimary media organization for whom you write or report(Required) (enter name or write “none”)Briefly describe the nature of your work over the last 3 months about health/medicine/medical research. What is approximate number, topic, length and placement of published pieces.(Required)(include any newspaper articles, tv sports, radio programs, blog posts, etc.)Briefly describe your target audience?(Required)(use less than 250 characters)About how much of your professional time is spent on stories about medicine, health or science?(Required) <25% 25% – 50% >50% – 75% >75% Education and training(Required) No formal education or training in health or science field Undergraduate degree in health or science field Graduate degree in health or science field Enrolled in some health or science journalism courses Completed health journalism fellowship Other (check all that apply)OtherWhy do you want to attend this workshop?(Required)(use more than 400 characters)What do you hope to gain from participation?(Required)(use more than 400 characters)How did you hear about the workshop?(Required)(use more than 200 characters)Please note any potential conflicts of interest (e.g., funding or employment by pharma, device manufacturers, specialty societies) or write "none".(Required)(use more than 200 characters)Would you need lodging for the workshop?(Required) Yes No Can you commit to attending the entire workshop?(Required) Yes No Δ