BETTER GOVERNMENT ASSOCIATION 2015 Richard H. Driehaus Foundation Awards for Investigative Journalism Page 1: Entry Form By entering this contest, you and your organization grant the Better Government Association (BGA) permission to use the entry, including the information on this form and the questionnaire. Such uses may include print, video or online resources, compilations of award tapes and/or streaming video from the BGA website. The authorized signature of at least one entrant or the contest coordinator, by and/or on behalf of the respective news organization is required for contest entry. Winners will be notified and a list posted on BGA websites/social media streams. **DEADLINE: SUBMISSIONS MUST BE POSTMARKED BY JAN. 31, 2015. Authorized Name: _____________________________________ Title: __________________________ Authorized Signature: __________________________________ Title: __________________________ CONTACT INFORMATION Name: _______________________________________________ Title: _________________________ Station/Company: ____________________________________________________________________ Station/Company Address: _____________________________________________________________ City: _______________________________ State: _________________ Zip: _____________________ Phone: _________________ Fax: _________________ E-Mail: ________________________________ ABOUT THE ENTRY Title: _______________________________________________________________________________ Medium (circle all applicable): Print Television Web Radio Topic: ______________________________________________________________________________ Type of Gov’t Abuse (circle all applicable): Waste Corruption Mismanagement Inefficiency Date(s) Published: _________________________________ Length: ____________________________ Contributors: List contributors to the entry in the order they should appear on plaques or certificates. If this entry is named a winner, only those listed below will be entered into the official records. 1. ________________________________________ 2. ______________________________________ 3. ________________________________________ 4. ______________________________________ 5. ________________________________________ 6. ______________________________________ BETTER GOVERNMENT ASSOCIATION 2015 Richard H. Driehaus Foundation Awards for Investigative Journalism Page 2: Questionnaire Please use another sheet (or sheets) to answer the following questions, using the numbering of each question on the form. If submitting your entry elecronically, please send responses as a separate document. The questionnaire must be included with each entry. 1. Title of the story (if part of a series, include the series title) and the names of the people who worked on it: 2. When did the story publish or air? 3. What is the main topic, and provide a synopsis of the series, including major findings: 4. Tell how the story got started (tip, assignment, etc.): a. What were the major types of documents used? b. Were Freedom of Information Act (FOIA) requests needed? c. What types of human sources were used? 5. What was the story’s result? 6. Has there been follow-up? a. Has there been a clarification or correction on the report? b. Has anyone come forward to challenge its accuracy? ___________________________________________________________________ Once complete, mail eight HARD copies of your submission, along with the entry form and answers to the questionnaire to: Mary Frances O’Connor Better Government Association 223 West Jackson, Suite 900, Chicago, IL 60606 o) 312.821.9026 f) 312.821.9038 email@example.com **DEADLINE: SUBMISSIONS MUST BE POSTMARKED BY JAN. 31, 2015.
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