------------------------------------------------------------ 1st Intenational School on Methodologies and Tools for Human-computer Interaction Jointly Organised by UNU-IIST, PUC-Rio and IRIT 17-21 September 2007, Rio de Janeiro ------------------------------------------------------------ APPLICATION FORM ------------------------------------------------------------ ***** Please edit this file and save it as plain text. ***** ------------------------------------------------------------ mark [X] to select a choice, leave [ ] unmarked, oterwise ------------------------------------------------------------ Surname: Given Names: 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] 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 [ ] [ ] [ ] [ ] 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)