APPLICANT PERSONAL INFORMATION ARE YOU PRESENTLY CREDENTIALED WITH THE NYPD? * YesNo FIRST NAME * MIDDLE INITIAL LAST NAME * POSITION (eg. Reporter, Anchor, Producer, Director, Technician, etc.) * DATE OF BIRTH * IF YOU ARE NOT EMPLOYED BY THE ABOVE ORGANIZATION ON A FULL-TIME BASIS PLEASE EXPLAIN YOUR STATUS: APPLICANT CONTACT INFORMATION BUSINESS TELEPHONE NUMBER * HOME TELEPHONE NUMBER * MOBILE TELEPHONE NUMBER * PRIMARY EMAIL ADDRESS * HOME ADDRESS: STREET * HOME ADDRESS: CITY * HOME ADDRESS: STATE * HOME ADDRESS: ZIP CODE * MEDIA ORGANIZATION INFORMATION NAME OF ORGANIZATION * DIVISION OR DEPARTMENT * ORGANIZATION URL * ORGANIZATION ADDRESS: STREET * ORGANIZATION ADDRESS: CITY * ORGANIZATION ADDRESS: STATE * ORGANIZATION ADDRESS: ZIP CODE * SPECIFIC ASSIGNMENT * CERTIFICATION: I hereby certify that the answers to the above questions are true. I also understand that in consideration of receiving temporary press credentials, I will also be in possession of photo identification. I also understand that the credential is non-transferable and that it may be removed by an officer or NYPD official at any time. CERTIFY? * Yes

Help: