INTERNATIONAL CENTRE FOR ADVANCED MEDITERRANEAN AGRONOMIC STUDIES (CIHEAM)
MEDITERRANEAN AGRONOMIC INSTITUTE OF ZARAGOZA (IAMZ)

APPLICATION FORM
-------------------------------------
to be returned, with a detailed Curriculum Vitae and accrediting documents to:

MEDITERRANEAN AGRONOMIC INSTITUTE OF ZARAGOZA
Avenida de Montanana 1005 - 50059 Zaragoza (Spain)
Tel.: +34 976 716000 - Fax: +34 976 716001
e-mail: iamz@iamz.ciheam.org
Web: http://www.iamz.ciheam.org

IF YOU FILL IN THIS FORM BY HAND, PLEASE USE CAPITAL LETTERS

NB: The forms received via e-mail will be considered only as pre-applications. In order to make an application definitive, a detailed Curriculum Vitae, together with accrediting documents, is to be sent to IAMZ.

1 - NAME OF THE COURSE YOU WISH TO FOLLOW (Indicate title and date):




2 - PERSONAL DATA

Family name:
First name: 
Sex:
Date of birth (d/m/y):
Nationality:
Private address (street, no., floor):
Town:
Province:
Country:
P.O. Box:
Post code:
Tel. (Indicate country and area codes):
Fax (Indicate country and area codes):
e-mail:

3 - EDUCATION (Attach copy of the transcript of records in applications for courses of Master programmes)

UNIVERSITY DEGREE:
University:
Years of study: 19__ - 19__
(Repeat this section as many times as necessary)


FURTHER DEGREES:
University:
Years of study: 19__ - 19__
(Repeat this section as many times as necessary)



TRAINING STAGES:



4 - EMPLOYMENT OR ACTIVITY

University/Institution/Firm:
Faculty/Centre/Delegation:
Department/Section:
Present position:
Present post held since (indicate date):
Work address (street, no., floor):
Town:
Province:
Country:
P.O. Box:
Post code:
Tel. (Indicate country and area codes):
Fax (Indicate country and area codes):
e-mail:
Web:

Previous employments:


5 - GIVE A DESCRIPTION OF YOUR CURRENT PROFESSIONAL ACTIVITY
(Use all the space necessary)



6 - MOST IMPORTANT PUBLICATIONS RELATED TO THE COURSE
(Use all the space necessary)



7 - REASONS FOR APPLYING TO THIS COURSE (Use all the space necessary)




8 - NAME AND ADDRESS OF TWO RESEARCHERS OR PROFESSORS ACQUAINTED WITH YOUR PROFESSIONAL QUALIFICATIONS AND ACTIVITIES (Use all the space necessary)




9 - LANGUAGE KNOWLEDGE (answer VG = Very Good, G = Good, F = Fair, N= None)

ENGLISH
Read:
Spoken:
Written:
FRENCH
Read:
Spoken:
Written:
SPANISH
Read:
Spoken:
Written:

10 - ADDITIONAL RELEVANT INFORMATION (Use all the space necessary)







11 - FINANCIAL SUPPORT

YOUR PARTICIPATION IN THE COURSE WILL BE FINANCED BY (put X where applicable)
The applicant:
Applicant's business institution:
Another institution (indicate name):

HAVE YOU APPLIED FOR A GRANT TO ANY OTHER ORGANIZATION? (reply Yes or No and indicate the name of the organization):


REQUEST OF GRANT FROM CIHEAM (member countries only: Albania, Algeria, Egypt, France, Greece, Italy, Lebanon, Malta, Morocco, Portugal, Spain, Tunisia, Turkey)

Do you request a grant for registration fees? (reply Yes or No):
Do you request a grant for accommodation? (reply Yes or No):

Would you participate in the course without a grant for registration fees? (reply Yes or No):
Would you participate in the course without a grant for accommodation? (reply Yes or No):


12 - FULL NAME AND ADDRESS OF THE PERSON TO BE NOTIFIED IN CASE OF EMERGENCY

Family name:
First name:
Address (street, no., floor):
Town:
Province:
Country:
P.O. Box:
Post code:
Tel. (Indicate country and area codes):
Fax (Indicate country and area codes):
e-mail:



I certify that to the best of my knowledge the information given is correct and I agree to inform of any modification

Date:

Signature:



______________________________________
In accordance with the provisions of the Organic Law 15/1999 of Protection of Personal Data, please be informed that the
data you provide will be entered into a file for which the Mediterranean Agronomic Institute of Zaragoza is responsible in
order to process your application procedure and to inform you, by mail or e-mail, about future activities on your thematic
area of interest. You may exercise your right to gain access to, rectify, cancel and contradict this information by making
a Subject Access Request addressed to the Mediterranean Agronomic Institute of Zaragoza, Avenida de Montaņana, 1005; 50059
Zaragoza, together with copy of your National Identity Card or equivalent.