------------------------------------------------------------ Application for Scholarship to attend ICTAC 2006 Sponsors University of Tunis El Manar University of York UNU-IIST 20-24 November 2006, Tunis, Tunisia ------------------------------------------------------------ APPLICATION FORM ------------------------------------------------------------ ***** Please edit this file and save it as plain text. ***** ------------------------------------------------------------ mark [X] to select a choice, leave [ ] unmarked, oterwise ------------------------------------------------------------ Name: Company/University: Current position: Research Interests (if any): Citizenship: Address: City: State: Country: Post code: E-mail: Phone: Fax: Web (if any): Date of Birth (DD/MM/YYYY): Higher degree: [ ] University graduate [ ] Master [ ] PhD awarded by (university): on (date, DD/MM/YYYY): Previous positions (Industry/Academia): * Years: Institution/Company: Position: [Repeat the three lines above, if necessary] Please mark if applies: [ ] I have a paper accepted at ICTAC 2006 [ ] I have applied to attend the ICTAC School [ ] I have requested financial support to attend the ICTAC School FINANCIAL SUPPORT: [ ] Financial support required. ENGLISH (self-assessed) Excellent Good Average Poor Reading [ ] [ ] [ ] [ ] Speaking [ ] [ ] [ ] [ ] Writing [ ] [ ] [ ] [ ] Listening [ ] [ ] [ ] [ ] Teaching experience: _______________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ Industrial experience: _____________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ Programming experience (including OS and Tools): ___________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ Research experience: _______________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ Reasons for attending this school: _________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ Expectations from this school: _____________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ Please attach: 1) Scanned copies of the university transcript for the completed undergraduate degree. 2) List of publications (if any)