Media Interview Request Form - Draft

Thank you for your interest in the Louisiana Department of Environmental Quality. Please fill out the form below to request an interview. We will review your request and get back to you.

Requester Contact Information

Name:

(First)

(Last)

Media Outlet Name:

Position/Title:

Phone Number:

Email Address:

Interview Details

What is your preferred interview date?

What is your preferred interview time?

What is the estimated interview duration?

What is your preferred interview location?

(In-person address or virtual platform such as Zoom, Skype, etc.)

Who would you like to interview?

What is the interview subject/topic?

(Please provide a description of the topic and any specific issues you wish to discuss.)

Who is the target audience?

What is the interview type?

Live

Pre-recorded

Written

Other

When is your deadline?

Additional Notes or Requirements:

ABOUT LDEQ

Media Interview Request Form - Draft