1

June 2014

Type of Advanced Training Desired:Graduate StudentResearch FellowResearch Intern

Field of Special Interest

PERSONALDate submitted (m/d/yyyy):

Name: / Given Name / Middle Name / Family Name
Organization:
Office Address:
Home Address:
Permanent Address:
Nationality: / Place of Birth: / Date of Birth / Date / Month / Year
Sex: F M / Marital Status: Single Married / Children No.:
Tel (O): / Fax (O): / E-mail (O):
Tel (H): / Fax (H): / E-mail (H):

EMERGENCY ADDRESS

Give names and addresses of persons to notify in case of emergency.

Name / Relationship / Tel/ Fax/E-mail / Address
Tel:
Fax:
E-mail:
Tel:
Fax:
E-mail:

EDUCATION

University or institution / City/Country / Major field / Degree obtained / Years attended
From (yyyy) / To (yyyy)

OTHER TRAINING

Course title / Place / Years attended
From / To
1.
2.
3.

EMPLOYMENT/EXPERIENCE

Present position and duties:
Previous experience / Organization / Years attended
From / To

Cite additional facts relevant to your application; i.e. academic and scientific honors, first-hand experience in vegetable crop production, published articles, etc.

LANGUAGE PROFICIENCY

Indicate your language ability below (excellent, good, fair, poor)

Language / Speak / Read / Write / Understand

FUTURE PROSPECTS

What do you expect your position and duties will be after this program at AVRDC?

Describe the type of program at AVRDC you think would be most valuable for you.

RESEARCH PLANS

Subject of research or investigation you would like to conduct:

Reasons for selecting this particular topic:
When do you wish to begin, if accepted?
How many months at AVRDC do you think would be optimal? benecessary?

FOR THIS PLANNED PROGRAM

I will pay all expenses myself

All expenses will be paid by (state clearly which organization or institution)

I have applied for a fellowship/financial aid from (state clearly which organization or institution)

SPONSORS:

Signature of employer and/or sponsor. Please print name under signature.

Signature / Address
Name / Title / Tel:
Signature / Address
Name / Title / Tel:
Signature of Applicant

ASSURANCE OF POSITION STATEMENT

Place
Date

To:

AVRDC - The World Vegetable Center

P.O. Box 42, Shanhua, Tainan 74199

Taiwan, Republic of China

This is to assure that / who currently holds the position of
(Position)
at the
(Organization)
in / will be granted a leave of absence and will be assigned
(City and Country)
be assigned to the position of
(Position)
at the termination of his/her program at AVRDC, should he/she be selected.
Name
Signature
Title of Position
Official Address

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June 2014