Click here to download form   Name Sex MaleFemale Date of Birth Citizenship Mailing Address City Country Afghanistan Alaska Albania Algeria Andorra Angola Argentine Armenia Australia Bahama Bahrain Bangladesh Belgium Belize Bolivia Borma Brazil Bulgaria Burkina Faso Cambodia Cameroon Canada Central Africa Chad Chile China Columbia Congo-Zaire Costa Rica CoteD'ivorie Cuba Cyprus Czechoslovakia Denmark Djibouti Ecuador Egypt El Salvador Ethiopia Finland Gabon Gambia Germany Ghana Greece Guatemala GuineaBissau Guyana Haiti Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Japan Jordan Kenya Kuwait Lebanon Liberia Libya Luxembourg Magnolia Malawy Malaysia Mali Malta Mauritania Mexico Morocco Mozambique Namibia Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palestine Panama Paraguay Peru Philippines Poland Portugal Qatar Rumania Rwanda Samoa Saudi Arabia Senegal Sierra Leone Singapore Solomon Islands Somalia South Korea Spain Sri - Lanka Sudan Surinam Sweden Switzerland Syria Taiwan Thailand Togo Tongo Tunisia Turkey Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay USSR (Russia) Vatican City Venezuela Vietnam Wallis Yemen Zambia Zimbabwe Postal Code/Zone Office Tele Home Tele Mobile Fax No E-mail Job Title Institution Name Department Organization Type International, Regional or Multilateral Organization Ministry State, Province, or Municipal-Level Government Media Private Sector Other Research Institution University or Other Training Institution NGO or Other Non-Government Community Org Governmental Agency   Have you previously applied to an SRC workshop? Yes No Have you previously attended an SRC workshop?  YesNo Your Current Professional Duties   Employment Experience (Please list previous positions with a brief description of your duties/responsibilities.)Title - Company/Institution - Dates   Title Company/Intitution Dates Education and Training (Institution and Location - Dates - Major Field of Study).   Institution and Location Dates Major Field of Study Language Proficiency Most sessions will be conducted in English. In order to benefit from the workshop, please indicate your proficiency in the English language: Written English    Fair Good Very Good Excellent Spoken English   Fair Good Very Good Excellent Which language do you normally use for work?   Special Interest in the workshop (Are there specific skills, tools and topics that you would like to acquire or explore?)   Connectivity Do you have access to a computer?  Home Work Both Do you have access to the Internet?  Home Work Both Eligibility (Please fill this section very carefully. Acceptance for this workshop is highly competitive. Criteria for acceptance include) I.  Institutional support Are you applying as  IndividualInstitutional Institutional applications are given higher priority. To be considered as such, you must attach a nomination letter from your institute. II.  Availability of Funding Are you applying for a sponsorship  YesNo Name of organization Contact person Address Telephone Fax E-mail The SRC has a limited number of scholarships for highly qualified applicants. Please state your needs   Travel Tuition Living expenses Travel & Tuition Travel & Living expenses Tuition & Living expenses All of these III.  Relevance of the workshop to the applicant's field of work (Please give your reasons for applying to the workshop and how it will improve your work performance.)