First West African Graduate Course on Food Composition and Biodiversity

Title
Dr. Mrs. Mr. Ms.

First Name & Initials

Family Name

Date & Place of birth

Nationality

Qualifications including degrees, diplomas and certificates held (state awarding body and date)

Work Address

Address for correspondence (if different from above)

Tel

Fax

E-mail

Name and Address of current employer

Doyou have permission of your employer to attend the course? Yes No

 

Will your employer meet the cost of you attending the course by paying for the tuition fees, travel, allowances? Yes No If yes Attach letter confirming the above here (Note: you will need to mail the hard copy to the organizers)

Do you accept to do pre-course work? Yes No

Can you bring your own dataset to the course? Yes No

If Yes, attach a file briefly describing you dataset, your major fields of interests in food composition, as well as your expectations on the course - (what you want to gain), and the expected application of the acquired new knowledge in the future.

The Invoice for tuition fees should be sent to: None Candidate Employer Other

If not candidate, then provide the name and Address, including email and fax of the person/institution providing the funds.

 

Declaration and signature of candidate seeking admission

I declare that the information given on this form and in the attached documents is correct. I have read and understood the arrangements for payment of tuition fees to which I will adhere. I understand that the course may be cancelled if numbers prove insufficient, and in such circumstance course fees will be refunded.

Attach your curriculum vitae here

Date

Signature