Application Form /Başvuru Formu

U N C C D / / / Ministry of Environment
and Forestry

APPLICATION FORM /BAŞVURU FORMU

A copy of the completed Application Form should be sent by fax or email toTIKA Office

A recent photographshould be

attached here,

signed legibly

on the reverse

— Each question must be answered clearly and completely. Type or print in black ink.

—If more space is required, attach additional pages.

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TITLE OF THE ACTIVITY:

“Erosion Control, Afforestation and Rehabilitation of Degraded Forest Lands Techniques,”

1-5 November 2010, Denizli, Turkey

Language of the course: Turkish andEnglish

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SURNAME:First name:Middle name(s):

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Place of birth : (city and country)Present nationality:Date of birth: (day - month - year)

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MaleFemaleMarital status:

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Home address:

Tel. no.:

Fax no.:

City:

Country: Post code:E-mail:

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Passport Number:

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Name and address of person to notify in case of emergency

Name:Relationship:Tel. no.:

Address:

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ACADEMIC BACKGROUND (higher degrees) start with the lastinstitution attended

Name of University (or equivalent) / Location / Main field of study / Period / Degrees

Subject of specialization:

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Languages

What is your mother tongue?

Knowledge of Turkish:

Excellent / Good / Average
Speak:
Read:
Write:

Knowledge of English:

Excellent / Good / Average
Speak:
Read:
Write:

Knowledge of Russian:

Excellent / Good / Average
Speak:
Read:
Write:

What other languages are you proficient in?

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INSTITUTION OR ORGANIZATION

Name and full address of permanent institution:Tel. no.:

Telefax:

Telex:

City:E-mail:

Country: Post code:

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Field of activity of your institute or organization:

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Describe your present employment duties, particularly in relation to your organization or department, stating also any positions you hold in management or administration and give a brief account of your work, its highlights, your present specific reserach area

PREVIOUSEMPLOYMENTS AND RESPONSIBILITIES

Describe your past (last five years) employment activities and duties in your institution or organization

Name of employer / Position held and period / Field of activity / Tasks and responsibilities

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RECORD OF SCIENTIFIC ACTIVITIES

Research projects undertaken:

Awards/scholarships:

Projects/patents:

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PUBLICATIONS (specify the number of your publications inc. books, articles and give the title of max. 5 of your most recent papers (relevant to the subject of this particular activity) as well as the precise reference.

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MEMBERSHIP TO SCIENTIFIC ASSOCIATIONS OR PROFESSIONAL ORGANIZATIONS

Please specify your function and activity in such organization(s)

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conventions, conferences, Seminars aND SCIENTIFIC VISITS

Name and placesYear

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Explain your reasons for wishing to participate in this activities and how you expect to contribute

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REFERENCES:

AGM and TIKA requires the name and address of one of three referees in support of your application. One of them should be National Focal Point of United Nation Convention Combating of Desertification.

NamePosition heldAddress

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Signature of candidateDate