APPLICATION FORM

UME 2004 INSTITUTE IN

SUSTAINABLE DEVELOPMENT POLICIES

Application Form- page 1

I- IDENTITY

·  Your name as it is exactly spelled on your passport (first name, middle name, family name)______

·  Sex: M F

·  Date of Birth: Month:______Day:______Year:______

·  Place of Birth (City, Country):______

·  Citizenship(s):______

·  Marital status: single married divorced

·  Ages of Children (if any): ______

·  Complete Mailing Address (VERY IMPORTANT: We must be able to reach you at this address until late June 2004): ______

______

City:______Country:______Zip code:______

·  Phone number where you are most likely to be reached in the evening (VERY IMPORTANT: phone interviews will be conducted from 6 to 11 p.m. your time):

(country code)______- ______

other phone number: (country code)______- ______

(please indicate time availability): ______

·  Fax (if available):______

·  E-Mail (if available): ______

·  How did you learn about the University of the Middle East Institute in Sustainable Development Strategies? 1)Your department 2) Your Director

3) Colleague or Friend 4)UME alumni Name of Alumni:______

5) Flyer 6) Advertisement 7) Online 8) Other : ______

· Have you applied to the ISD Previously?

If so, please check year (s) 2000 2001 2003

· Do you have relatives applying to one of UME’s Institute this year? Yes No

if yes, which Institute? ______

Application Form- page 2

II- EDUCATION

1. Educational Background: List institutions attended (High School, University, Institutes, Etc.) – Please begin with the last institution attended.

Name
of Institution / Location / Dates attended / Diploma/Degree / Field

CURRENT ACADEMIC PROGRAM (2003-2004) IF APPLICABLE

Name of the Academic Institution in which you are currently enrolled: ______

______

In which degree and in which field? ______

______

· In your current Institution, how much tuition and fees do you pay each year (in your local currency and if possible converted in US$): ______

· Do you benefit from a scholarship and if yes, how much? ______

· List the courses you are taking in the academic year 2002-2003:

______

______

Application Form- page 3

2. Knowledge of Languages

· Native Language:______

· English: number of years of practice: ______

Level of written English: Excellent Very Good Good Fair Poor

Level of Spoken English: Excellent Very Good Good Fair Poor

· TOEFL score (not required) : ______; Date:______

· Other equivalent Test: ______; your score: ______

Maximum possible score: ______; Date: ______

· Have you taken courses in your field of studies that were taught in English, and if yes, which course

______

______

· Other Languages or Dialects:

Other languages or dialects: / Years of practice / Written level
(excellent, …., poor) / Spoken level
(excellent, …, poor)

3. Computer usage:

How familiar are you with using computers?______

Years of practice: ______

Type of computer most commonly used (PC or Mac) : ______

List software used (ie: Microsoft Word, Excel, Powerpoint, Front Page etc.)______

______

4. Other skills and qualifications:

Please list any other skills and qualifications:

Application Form- page 4

III- PROFESSIONAL EXPERIENCE

1.  List the names of all the professional activities you have had (including activities on a volunteering basis), starting by the latest:

Name of company, administration,
NGO, association. / Location / Dates and duration / Job description and responsibilities

2. Please list work projects you have designed, implemented or taken part into (for each project, please specify your role and responsibilities) – Please describe in details one (or more) of these experiences dealing with development and/or environment issues:

Application Form- page 5

(description of projects – continued)

Application Form- page 6

3.RESEARCH PROJECTS AND PUBLICATIONS (IF APPLICABLE)

Please list any past or present research projects you have worked on, along with the publications you wrote:

In the space provided below, give a short summary of any past or current research project on topics relating to development and/or environment issues. If you are currently enrolled in a Masters or Ph.D. program, please briefly describe your current research topic.

Application Form – page 7

IV- PREVIOUS BACKGROUND AND TRAINING OBJECTIVES

In the table below, please rank your current knowledge and understanding of the fields listed

Note: 0 = no previous background, ...5 = very good mastery of concepts, methods and tools. As the composition of the group will be multidisciplinary, it is expected that some of these values will be zero.

Topic / value / value
Biology / History
Ecology / Anthropology, Sociology
Chemistry / Demography and Population studies
Physics / Political Sciences
Statistics / Law
Economics / Business and Management

List here other fields where your level of knowledge/understanding would be ranked 4 or 5:

Please rank in the table below the level of your knowledge/expertise in each of the following subjects using the 0-5 scale ( where 0 = no interest and 5 = extremely interested).

Topic / value
Global climate change, and effects on MENA region
Biodiversity and sustainable management of ecosystems (land, forests, wetlands, coastal zones,..)
Monitoring and instrumentation technology including remote sensing and GIS
Environmental risk perception, assessment and communication
Sustainable Agriculture and Sustainable management of natural resources
Water scarcity, water management and policies in the MENA region
Rural development policies in the MENA region
Sustainable Tourism
Urban planning in the MENA region (water management, waste management, transportation, housing,...), environmental planning of urban areas.
Cleaner production and energy use, industrial ecology, corporate environmental management
Environmental regulations at global level (international agreements, Kyoto, etc...)
Environmental Policies at the national level in the MENA region
Environmental law and diplomacy
Local governance, civil society and environment in MENA countries
Economics of sustainable development
Environmental ethics and equity
Poverty and environment , population and environment relationships
Trade and environment
Historical and comparative perspectives on development

Other topics (please identify):

Application Form -page 8

Are you more interested in learning new theories, concepts and methods or new tools and practical skills or both (please explain your motivations):

What else do you expect to learn at the Institute in Sustainable Development Policies of the University of the Middle East Project?

How do you see your work upon returning home as helping your country to improve its sustainable development policies capacity? How might you share your training with others?

Are there areas in which you feel qualified to give a professional presentation that could interest other participants in the program? If so, on which topics?

Application Form – page 9

V- CAREER PLANS

What are your career/educational plans for the next two years?

If you have applied to several academic programs for 2003/2004, please indicate in which universities and which countries and the date when you will receive the response to your application:

University (country) / Program/Degree / Field / Date of response

What are your career plans for the next 10 years?

If there is anything else you would like us to know about yourself, please feel free to express it here:

I hereby certify that the information given in this application is complete and accurate

Signature of applicant: ______; Date: ______