APPLICATION FORM CERG 2009
(To return before: November 16, 2009)
PHOTO□ Ms □ Mr. Surname………………………….……….. Name …………………………………
Date of birth ……………………………………………… Citizenship…………………………….
Marital Status …………………………………………………………………………………………
Professional Data
Institution......
Address......
Tel ………………………………. Fax...... ……………… E-mail………………………………...
Current position……………………...... Employer......
Personal Data
Address......
Tel…………………………………Fax...... …….. E-mail………………………………...
EDUCATIONAL BACKGROUND
School degree : (type, name of school, year)......
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University degree :
B.S...... Name of university...... Year......
M.S...... Name of university...... Year......
PhD...... Name of university...... Year......
Other degrees......
LANGUAGE EXPERTISE (indicate appropriate language level: P=Poor, F=Fair, E=Excellent)
ReadingWritingSpeaking
English ......
French ......
Other known languages …………………………………………………………………………….
COMPUTER KNOWLEDGE
(Please indicate operating systems and softwares you are familiar with, in particular GIS and Modelling)
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REQUIRED DOCUMENTS FOR THE SELECTION TO BE ATTACHED:
-a short Curriculum Vitae (max 2 pages)
-copies of certificates and diplomas, copies of official transcript of grades
-a short proposal of your potential research project for the CERG Mémoire (see WebPage for details) (max 1 page)
- list of publications (if any) and a copy of 1 or 2 relevant publications (if any)
-two recent letters of recommendation with name, address, phone number, fax number and academic/professional relationship letter from your Employer or Supervisor authorizing your CERG application
-copy of your passport or ID
PART TWO
INFORMATIVE DATA
What are your reasons for applying to the CERG program?
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What are the possibilities after the training to practice the acquired knowledge in your institution / country ? Please, enclose a letter attesting to your professional experience or the possibility of working in this field in the future.
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If you are not currently employed, in which specific areas are you planning to work?
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Would you be interested in participating (at your own expense) in a 3-month internship at an International or National Organisation as part of your final Memoir? If yes, please indicate the specific areas in which you are most interested to work.
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Do you have pre-existing physical conditions that can affect your field work activities (e.g. asthma, etc)? If yes, which type(s)
(Field work implies climbing on top of a volcano with gases emission (e.g. SO2) and in altitude in the Swiss Alps)
Do you need accommodation?yes no
Please indicate the expenses you or your institution can support in addition to the travel costs? Training fees living expenses
IF ANY DOCUMENTS ARE MISSING, YOUR APPLICATION WILL NOT BE PROCESSED
ADDITIONAL MATERIAL
During the training course you will have the opportunity to produce your work on a particular Hazard/Risk related to your own country. Please bring along any relevant material (e.g. pictures, maps).
Date ...... Signature......
This application form must be sent before November 9th 2008 to
Coordination CERG –Sciences de la Terre,
13, rue des Maraîchers - CH-1205 Genève, Switzerland,
Tel. + 41 22 379 66 02, Fax + 41 22 379 36 01
Email:, web Site: