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Application Form

A regional workshop on "GIS Applications in Climate Change"


18-22 September 2016, Cairo, Egypt

I. PERSONAL DATA
Title:
Family name:

First name: ..

Gender:

Date of birth:..

Position: .
Affiliation: ..
Nationality:
Country of current residence: ..
Contact address:

Email: .
Phone number: ................................................................................

II. EDUCATION & PROFESSIONAL EXPERIENCE


University degree: ...........................................................................
Further degrees: ..............................................................................
................................................................................................................

Can you bring a laptop computer with you to the training?


Yes

No

Do you have ArcGIS Desktop license type installed on your laptop?


Yes

No

If yes, which version of ArcGIS do you have installed?


9x
10x
If yes, which license of ArcGIS do you have installed?

ArcView

ArcEditor

What is your proficiency level in English?


Spoken
Excellent
Good

ArcInfo

Fair

Limited

Fair

Limited

Written
Excellent

Good

How do you think the workshop that you have applied for may be useful to you? Illustrate using
specific examples as much as possible.

III. FINANCIAL SUPPORT


Do you request a grant for travel?

Yes

No

Would you participate in the course without a grant for travel costs?

Yes

No

IV. EMERGENCY CONTACT INFORMATION


Title:
Family name: .
First name:
Position: .
Nationality:
Contact address:
Email:
Phone number:
Please:
a. Send your application forms not later than 15/08/2016 by email to the following address:
info@arca-eg.org
b. Please attach your short curriculum vitae
c. Selected candidates will be notified via email by 21/08/2016
For further information, call: +2 03 4249290
I certify that all of the information above is to the best of my knowledge and correct

Date:

Signature: