/ East and Southeast Asia
P.O. Box 1010
(KasetsartUniversity)
Bangkok10903, Thailand
Tel: +66-2-942-8686
Fax: +66-2-942-8688
Web:
Email:

APPLICATION FORM

33rdInternational Vegetable Training Course

“Vegetables: From Seed to Table and Beyond”

15 Septemberto5December 2014

AVRDC Research and Training Station

Kasetsart University, Kamphaengsaen Campus

Nakhon Pathom, Thailand

PERSONAL INFORMATION (Kindly print legibly. Theinformation provided below must match those indicated in your passport)

Given Name
Middle Name
Family Name
Nationality / Date of Birth (dd/mm/yyyy)
Place of Birth / Passport Number
Date and Place of Issue / Date of Expiry
Sex / Marital Status
Office Name
(Employer)
Office Address
Home Address
Tel (O): / Fax (O): / E-mail (O):
Tel (H): / Fax (H): / E-mail (H):

EDUCATIONAL BACKGROUND (last two institutions only)

Name of Institution/location / Degree / Years Attended
From / To

Have you attended previous AVRDC Training Courses? _____ YES ____ NO

If yes, please indicate the year: ______

EMPLOYMENT/EXPERIENCE

Present job/position
Main responsibilities
Previous job(s)/position / Office, location / Years of / Service
From / To

ENGLISH PROFICIENCY:

Since the course language will be English, a certain level of English proficiency in written and oral form is required to fully benefit from the course. Please tick your level of proficiency below:

 Test of English as a Foreign Language (TOEFL): _____ score for paper based test; _____ score for a computer-based; ____ score for internet-based test.

 International English Language Testing Service (IELTS): _____ score

 Completed university education where the subject English comprised the main component of the course of study.

 Other proof of English proficiency, please specify:

FINANCIAL SUPPORT[1]

 Personal

Donor funded

Sponsoring agency:
Contact person in sponsoring agency:
Contact details:
(Phone/Fax/Email)

I am interested to join the training but do not have any financial means to participate.

Whichmodule(s) would you like to attend for this training? Please tick.

 Module I: “From Seed to Harvest”, 15 September to 10 October 2014

Module II: “From Harvest to Table”, 13 October to 7 November 2014

Module III: “Vegetables for Sustainable Development”, 10 November to 5December 2014

Food restriction:I am strictly vegetarian I cannot eat beef  I cannot eat pork 

I cannot eat ______

CONTACT INFORMATION (Person to contact in case of emergency)

Name
Relation
Address
Contact details (phone/fax/email)

YOUR MOTIVATION

Please state briefly the reason for applying to this training course, your main field of interest within the training course and how you hope to benefit from the training course (no more than one page).

ASSURANCE OF POSITION STATEMENT

Place: ______

Date: ______

To:

AVRDC – The Word Vegetable Center

Regional Office East and Southeast Asia

P.O. Box 1010 (Kasetsart University)

Bangkok 10903, Thailand

This is to assure that ______who currently holds the position of

(Name)

______

(Position)

at the ______

(Organization)

in ______will be granted leave of absence and will be

(City/Country)

assigned to the position of

______

(Position)

at the termination of the advanced training, should he/she be selected.

Name: ______

Signature:______

Title of position:______

Official address: ______

______

______

[1]Please note thatAVRDC does not provide scholarships for the 33rd IVTC.