2017 International Seminar on Protected Area Management
June 27 – July 17, 2017
Application Form
Section 1 – Application Information
Surname (last name)
Given Name(s)
Please type your name as it appears on your Passport
Nickname
Date of Birth (mm/dd/yyyy)
Male
Gender
Female
City of Birth
Country of Birth
Country of Citizenship
Country of Legal Permanent Residence
Work Information
Job Title
Work Phone Number
Institution/University/Organization
Alternate Phone Number
E-mail Address
Do you have reliable e-mail access?
Yes
How frequently do you have e-mail access?
Work Fax Number
Alternate E-mail address
No
Work Address (Delivery Address for DHL/UPS/FedEx)
Please note: It is important that you provide an address suitable for use by a delivery service such as DHL, UPS or FedEx. Most international
delivery services will NOT deliver to a post office box. They usually require a road, highway or building complex address.
Organization:
Street Address:
City:
Province/State:
Postal Code:
Country:
Passport and Visa Information
Passport Number
Country of Issue
1
Date of Issue (mm/dd/yyyy)
Date of Expiration (mm/dd/yyyy)
Do you currently have a visa for entry into the United States?
If yes, what type of visa?
J-1
B-1
Visa Expiration Date (mm/dd/yyyy):
Have you ever been to the United States before?
Yes
Yes
No
No
If yes, please list dates and visa type for each trip:
Have you ever been to the United States on a J-1 or J-2 Visa?
Yes
No
If yes, please list dates and visa category:
Emergency Contact in the United States
Surname (last name)
Relationship
First Name
Email Address
Phone Number
Section 2 – Sponsor Information
Do you currently have financing to attend this seminar?
Yes
No
If yes, please complete the sponsor information. If no, please indicate the source of funding you have applied for and indicate the date by which
you expect to have notification of funding.
Sponsor Contact Name:
Sponsor Organization/Institution/University:
Sponsor Phone Number
Alternate Phone Number
Sponsor Fax Number
Sponsor E-Mail Address
Sponsor Address
Organization:
Street Address:
City:
Province/State:
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Postal Code:
Country:
Date of funding award or notification:
Funding will cover (check all that apply):
Seminar Fee
International Travel
Section 3 – Additional Background
Please rank which seminar theme is of most interest to you, on a scale of 1-4, with 1 indicating highest interest.
Integrated Planning for Protected Areas
Community Involvement in Protected Area Management
Tourism, Concessions, and Visitor Management
Transboundary Management in the Face of Climate Change
What skills/knowledge do you hope to acquire during this seminar?
Please mark your proficiency in English for reading, writing, speaking and listening comprehension.
Fluent
Intermediate
Beginner
Reading
Writing
Speaking
Listening
Are there other things you hope to gain from this experience or would like us to know?
Section 4 – Application Attachments
Please attach the following documents
Brief Resume
Photocopy or scan of passport information (and U.S. visa, if applicable)
Brief Description of Job Responsibilities
Brief statement of interest in the seminar
A statement of your willingness to camp in a remote, forest area for a few days (equipment is provided)
Section 5 – Logistics
Do you require vegetarian meals? YES____ NO____
T-shirt Size:
WOMEN’s: Small____ Medium____ Large_____ XLarge_____ 2XL______ 3XL______
MEN’S: Small____ Medium____ Large_____ XLarge_____ 2XL______ 3XL______
By signing below, I acknowledge that I have visited the seminar website and have read and agreed to the
policies listed in the FAQ section.
_________________
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Applicant Signature
Date
Completed applications should be returned to [email protected] or faxed to +1-406-243-4845 by April 1, 2017.
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