Application Form 2016

I6th International Course on

Integrated Mangrove Ecosystems Management

Please answer each question completely. All relevant information should be included here but if necessary, you may attach additional pages of similar size. Please complete in English and include a recent photo.

A. PERSONAL INFORMATION
Surname / First name / Insert Photo
Title / Name as it appears on Passport
Marital Status / Gender / Date of Birth (M/D/Y) / Age
Passport Number / Place of Passport issue
Passport Issue (M/D/Y) / Passport Expiry (M/D/Y)
Place of Birth (city, country) / Nationality / Country of Residence (time of application)
Telephone
Current Address
Mobile
Email
Permanent Address (if different from above)

EMERGENCY CONTACT

Name / Relationship / Telephone
Address / Mobile
Email

Start with the most recent first

Name and Location / Start Date / End Date / Field of Study / Degree

C. LANGUAGES

Start with your mother tongue first

Language / Speaking / Reading / Writing

Start with the most recent first

Name and Address of Employer / Job title
Duties and Responsibilities
Type of Organization (e.g., NGO, IGO, University, etc.)
Name of Supervisor / Start Date (M/Y) / End Date (M/Y)
Name and Address of Employer / Job title
Duties and Responsibilities
Type of Organization (e.g., NGO, IGO, University, etc.)
Name of Supervisor / Start Date (M/Y) / End Date (M/Y)
Name and Address of Employer / Job title
Duties and Responsibilities
Type of Organization (e.g., NGO, IGO, University, etc.)
Name of Supervisor / Start Date (M/Y) / End Date (M/Y)

ONLY TO BE FILLED IF APPLYING FOR A UNU FELLOWSHIP

Explain in 300-500 words the reason/s for applying for this fellowship

Previous fellowships, scholarships, or grants for your studies (date, source, place and subject)

Are you currently studying on a fellowship?

If yes, please list the name and address of the fellowship source

F. CERTIFICATION
Acceptance of conditions of the fellowship by the applicant
I have read the terms and conditions of the UNU-INWEH application described below and agree to accept them if this fellowship is awarded.
(a) To conduct myself appropriately and professionally at all times
(b) To return to my home country at the end of the fellowship period
Signature of Applicant: Date:
Acceptance of conditions of the fellowship by the Director of the applicant's institution or university
The studies to be carried out under this fellowship will strengthen the research programme and applied research of the country and of this institution.
If a fellowship is awarded,
(a) The recipient will receive a leave of absence for the fellowship period
(b) The absence of the recipient during the period of study will not adversely affect his/her studies, status, seniority, salary, pension, and similar rights.
Signature of Director: Date:
Director (title, first and surname)
Address of Institution / Telephone
Email
Is government clearance needed for your acceptance of this grant? If yes, please YES NO
provide a copy

G. LETTERS OF RECOMMENDATION

Please include two recommendation letters and add contact details of referees below

Referee 1 (title, first and surname) / Referee 2 (title, first and surname)
Address / Address
Telephone / Telephone
Email / Email

Pease mail completed application form to:

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Dr. K. Kathiresan

Professor, CAS in Marine Biology

Annamalai University, Parangipettai - 608 502, Tamil Nadu, India

Tel: 91 - 4144 - 243223 (Off), 238419 (Res.) Fax: 91 - 4144 - 243555

E-mail: ;