Entry Form : The Iowa Gallup Award
for Excellent Journalism Using Polls

Name ___________________________________________ Date __________________

News/Media Organization __________________________________________________

Address ________________________________________________________________

Phone: ________________________Email: ___________________________________

Title of submission _______________________________________________________

Published - Broadcast - On-line (circle one) on date ______________________________

Please provide name of publication, broadcast or URL ____________________________

Please provide the following about your story:

• Summary of the entry.
• Description of the involvement of each entrant in producing the story.
• Description of action or feedback generated by the story (if any).

The following poll information must be submitted with your entry:

• Survey sponsor
• Population sampled
• Size and description of the sample (and subsamples, if relevant)
• Interview dates
• Methods of sampling and interviewing
• Complete wording of questions reported
• Description of precision of findings, such as margin of error
• Description of percentages used for developing conclusions

Please submit seven copies of your entry to:
Arlecia D. Simmons, Program Assistant
The University of Iowa
School of Journalism and Mass Communication
100 Adler Journalism Building, Room E305
Iowa City, IA 52242

Thank you for your interest and participation!