Media Interview Reporting

Name or Signal Name *

First Name

Last Name

Date of Interview *

MM

DD

YYYY

Time of Interview

Optional

Hour

Minute

Second

AM PM

Interview Format *

In Person

Phone

Zoom, Google Meet, etc.

Email

Other

Was the conversation... *

On the Record

On Background (off the record)

Not Sure / Unclear

Has the story been published or aired? *

Yes

No