Course on. Environmental Economics for Development Policy (EEDP 8) Paris, France, July 18-29, 2005 APPLICATION FORM

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1 Course on Environmental Economics for Development Policy (EEDP 8) Paris, France, July 18-29, 2005 APPLICATION FORM Deadline for application is April 22, Early application is appreciated. It would be easiest to complete and return this form via , though you may fax or mail the completed application form to the contact information given below. Stefan Sittig MSN J4-400 Tel: The World Bank Fax: H Street, NW ssittig@worldbank.org Washington, DC USA Please attach your curriculum vitae (CV) along with the completed application form. PERSONAL INFORMATION Form of address: Mr. Female: Male: Mrs. Ms. Last Name: First Name: Date of Birth (mm/dd/yyyy): Citizenship: CONTACT INFORMATION Permanent Mailing Address: Work Address: Home Phone (including country and area codes): Work Phone (including country and area codes): Fax Number (include country and area codes): Address: 1

2 ACADEMIC BACKGROUND Specialization Bachelor (BA/BS) or equivalent Master (MA/MS) or equivalent PhD or equivalent Thesis Institution Location Dates ECONOMIC BACKGROUND AND PROFICIENCY Please indicate the type and amount of economic training you have had. Number of undergraduate economic courses at university: When: / / Number of graduate economic courses at university: When: / / Other type of economic training (please specify what type, how much and when): Mark with x those concepts you are familiar with: Supply: Demand: Marginal Cost: Public Good: Opportunity Cost: Consumer Surplus: Market Failure: Externality: Cost-Benefit Analysis: LANGUAGE PROFICIENCY Please indicate how proficient you are in English (mark with x ). Fair: Good: Excellent: 2

3 COMPUTER SKILLS Do you know how to use a computer (mark with x ). Yes No If yes, do you know how to use a spreadsheet (Excel, Lotus, Quattro Pro, Others)? Yes No Software: EMPLOYMENT Please list your three most recent employments and provide a brief description of your work and responsibilities. Title Current Employment (1) Employment before now (2) Employment 3 Position Employer Duration From up to now Tasks / Responsibilities Please mark with an x the appropriate classification or specify it. Type of Organization Government Private Sector Academia NGO Other (specify) Employment 1 Employment 2 Employment 3 Major focus Environmental Policy Environmental Law/ Regulation/Institutions Fiscal/Economic Instruments Public Awareness and Advocacy Environmental Evaluation Other (specify) Employment 1 Employment 2 Employment 3 3

4 CURRICULUM VITAE Accompanying this application form, please attach your curriculum vitae KEY ENVIRONMENTAL ISSUES What are three critical priority environmental issues to be tackled in your region/country? THEMATIC INTERESTS To help us better tailor the course to your needs, please indicate your primary thematic interest with a x (you may check more than one options): Primarily green or natural resource management issues If so, principally: Parks and protected areas: Forest resources: Fisheries: Water resources: Other (please specify): Primarily brown or pollution and its effects. If so, principally: Urban water and sanitation: Rural water and sanitation: Indoor air pollution: Outdoor air pollution: Solid and hazardous waste disposals: Pesticides / agri-chemicals : Other (please specify): Other (specify): 4

5 EXPECTATIONS Please briefly describe your expectations of this course: HOW DID YOU LEARN ABOUT THE COURSE? WBI Development Outreach: Advertisement in The Economist: World Bank / WBI Website: World Bank Country Office: Communication with Colleagues: Flyer: Other Course: If so, which course: Other (please specify): COURSE FEE AND ADDITIONAL EXPENSES Please check the fee category you fall into with x. The fee includes tuition, health insurance, training materials and use of computers. Applicant from World Bank borrowing countries (except those being sponsored by international organizations): US$ 500: Applicant from all other countries, including those sponsored by international organizations: US$ 3,300: Travel, lodging and subsistence are additional. Subsistence costs while in Paris are estimated to be approximately US$ 90/day. Each successful applicant will be responsible for seeking funding from his/her employer, government, foundations or other funding institutions to cover his/her expenses. HOTEL Please let us know whether you wish to organize lodging on you own or whether you wish to book accommodation through us (in the latter case, you will need to pay approximately US$ 1,400 for 12 nights) mark your choice with x. I will organize hotel accommodation by myself: I wish to let WBI reserve a room in a hotel for approx. US$ 1,400. 5

6 COUNTRY CLEARANCE AND VISA If in your country your participation is subject to clearance by the government, or to approval by a particular agency, a letter of clearance from the government or agency concerned must accompany this application. Invited applicants will be responsible for obtaining visa for participating in the EEDP course in Paris, France APPLICATION DEADLINE AND NOMINATION Application deadline is April 22, 2005 (Late applications will be considered depending on space availability). By April 30, 2005, accepted applicants should receive a notification letter to be presented to visa authorities, a registration form and payment information (via ). To the best of my knowledge the above information is true. Date: / / Sender s Name/Signature 6