PARTICIPANT REGISTRATION FORM
Send to Sekretariat PR IV Unand Email to:
seminar.pr4.unand@gmail.com sekretariat.pr4.unand@gmail.com
I wish to participate in the
International Competitive Proposal Writing Workshop Kampus Universitas Andalas, Padang
12-13 November and 19-20 November 2010
1 Full Name Male Female
4 Date, place and country of birth
5 College and/or university education
Name and place
From To Degree
Main studies
Thesis or major
6 English language proficiency ( fair F, good G, excellent E)
Read Write Speak Understand
F G E F G E F G E F G E
Was English the language of instruction in secondary school/ university? Y N
7 Present professional employment (use additional sheet if necessary)
Job Title From
Employer, name
Employer, address
Type of organization: government semi government private
Phone Fax E-mail
Responsibilities:
8 In case you are involved in the execution of a specific project:
Project name
Job Title
Responsibilities
Executing Agency
Financing provided by
9 Could you explain why you are interested to become a participant in this course?
9 Could you please write an idea which could be proposed to be proposal?, please refer following websites to find any potential donors: http://www.cknet-ina.org/index2.php?menu=donors
