Application Form

Wageningen International
CD&IC Programme
Market access and sustainable development 2007
November 5 – 16, 2007
Wageningen – The Netherlands
Code: 61/60
Duration: 2 weeks
Fee: € 2900
Closing date for application with NFP Fellowship: June 1, 2007
Application deadline with funding other than NFP fellowship: October 5, 2007

Personal Details

Last name: / Title:
First name: / Middle name:
Place of birth: / Nationality:
Email: / Telephone:
Gender: Male Female / Civil Status Single Married / Date of birth: / //
Contact in case of emergency:
Name: / Relation to applicant:
Town: / Email:
Country: / Tel:
Fax:
Employment Details
Name of Organisation:
Department: / Contact Person:
E-mail:
Address:
Street: / No:
Town: / Postal Code:
State: / Country:
Telephone: / Fax:
Type of Organisation: Government/Public NGO Private
Work experience (Please attach C.V. if more information is relevant)
Your position: / From:
Description of your work:
Previous Work Experience (related to the subject of the course) / From / To
Total number of years working experience (relevant or irrelevant to the course): / years

Academic Record

Field of Study / Educational Institution & Location / Qualification (e.g. BSc, MSc, PhD) / From / To
Other relevant training:
Computer Skills: Word Excel Access Other:

English Language Proficiency

Excellent Good Fair
Mother Tongue: / Language used in higher education:
Candidates from non-English speaking countries should attach a certificate of English proficiency, issued by a recognised language institute
please indicate your test score below if relevant
TOEFL score : / IELTS score:
Travel (list periods spent away from your home country for professional purposes)
Countries
/
Reasons for visit or residence abroad
/
Dates

What is the practical use of this course for your work?

/

Financial Arrangements

I have applied for sponsorship from:
All expenses will be paid by:
a supporting statement from the sponsoring organisation concerned should be attached
How did you learn about this course?
brochure Wageningen International / former participant / website Wageningen International
Enews Wageningen International / my employer / other website, namely:
Netherlands Embassy / other source, namely
I certify that I have answered the above questions truthfully,
Date: / // / Town:
If applicable, please attach your CV, a certificate of proficiency in English and a statement from a sponsoring organisation.

To be returned to:

Wageningen International

P.O. Box 88, 6700 AB Wageningen, The Netherlands

Fax: +31 (0)317 495 395 E-mail:

Or enroll online on www.cdic.wur.nl