------------------------------------------------------------ 1st Intenational School on Software Engineering and Formal Methods Jointly Organised by UNU-IIST and University of Cape Town 27 October - 7 November, Cape Town, South Africa ------------------------------------------------------------ APPLICATION FORM ------------------------------------------------------------ Please read carefully the Call for Application at http://www.iist.unu.edu/SEFM08/School/cfa.html then edit this file filling in all requested information and save it as plain text. ------------------------------------------------------------ mark [X] to select a choice, leave [ ] unmarked, otherwise ------------------------------------------------------------ Please note that incomplete applications will be disregarded ------------------------------------------------------------ Surname: Given Names: Gender (only for statistycal purpose): [ ] Male [ ] Female 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] Have you submitted or do you intend to submit a paper to SEFM 2008? [ ] Yes, the title is: _______________________________ __________________________________________________ [ ] No EXAMINATION: [ ] I would like to undertake an examination on the topics presented at the school (applicable only if this form is submitted no later than 16 June 2008) Credit requested for: [ ] PhD [ ] Master [ ] Other: ________________ at the University: ________________________________ Information required on the certificate for credit recognition: ______________________________________ ___________________________________________________ FINANCIAL SUPPORT: [ ] Financial support required. If financial support required, - From which place do you intend to travel? City: Country: Transportation: [ ] Air [ ] Land [ ] Sea - Estimated costs of a return trip: US$ _________ Native Language(s): Other languages (if any): ENGLISH (self-assessed) Excellent Good Average Poor Reading [ ] [ ] [ ] [ ] Speaking [ ] [ ] [ ] [ ] Writing [ ] [ ] [ ] [ ] Listening [ ] [ ] [ ] [ ] REFERENCES (at least two): 1) Name:________________________________________________ email:_______________________________________________ 2) Name:________________________________________________ email:_______________________________________________ 3) Name:________________________________________________ email:_______________________________________________ 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 (mandatory only for applicants who do not hold an academic position) 2) List of publications (mandatory only for applicants who hold an academic position)