International Tropical Timber Organization

(ITTO) Fellowship Application Form

Before filling out this form, please read the attached information note carefully. Type or print in dark ink. All relevant information should be included on this form, but if necessary, attach additional pages of similar size. Please check box with x where relevant. The application will not be accepted if it is not signed (electronic or hand written). A. SUMMARY OF PROPOSED ACTIVITY I apply for an ITTO Fellowship in the field of : Economic Information and Market Intelligence Reforestation and Forest Management Forest Industry Type of Proposed Activity: Short Training Course Short Training Internship (Attachment) Study Tour Lecture/Demonstration Tour Participation in Conference/Seminar/Workshop Technical Document /Preparation/Publication/Dissemination Post-Graduate Degree Program Title of Proposed Activities: (Please include name of Training Course/ Study Tour/Conference/Document/Host Institution etc.)

City & Country where the activities will be taken place: Starting Date:
(Please refer to Information Note) dd / mm / yy

Ending Date:
dd / mm / yy

Proposed Duration:

Amount of budget requested: B. IDENTIFICATION OF APPLICANT

US$

1. Name
Family Name/Last name First Name Middle Name

2. Title:

Mr.

Ms.

Dr.

Others:

3. Mailing Address: Telephone No. :

Country code-Area code-Number

Fax No.:
Country code-Area code- Number

E-mail 4. Birthplace : Birth date : Nationality:

: Gender: Marital Status: Male Single Female Married

LEAVE BLANK: For ITTO Use Only Application No. Missing documents: Application accepted: If not, why? Letter of Reference Course fee/description Yes Received after deadline Date of receipt of application Letter of Acceptance Brief proposal No Non member country Airfare pro forma invoice

Ineligible activity

Name: C. APPLICANT'S EDUCATION AND EXPERIENCE 5. Educational History (begin with current or most recent): Name of Institution (City/Country) Dates (mm/yy) - (mm/yy) Field of Study Degree

6. Language Skills: Mother Tongue/Official Language:

Indicate Language(s) in use where Fellowship is proposed and the skill level of the language with: E (excellent), G (good) or F (fair) Read Language E G F E Write G F E Speak G F

Please attach certificate indicating proficiency in language of study. Certificate attached? If no, please specify the reason: 7. Principal publications in last three years:

Yes

No

8. Previous Fellowships, Scholarships, or Grants:

(a) Have you ever been a recipient of an ITTO Fellowship Award? If yes, please describe it below. Dates of Award Title of Activities Period of Activities Host Country Yes No

(b) Other Fellowships/Scholarships/Grants: Dates of Award Funding Agency & Location Title of Award Subject

Name: 9. Employment History: Describe your work experience for your last two positions of employment, starting with your current or most recent position. Describe your role in this organization and its relation to the tropical forestry and/or timber industry sectors. Discuss your responsibilities, projects undertaken, and other professional accomplishments. Highlight any experience in research and development, writing, production, marketing, management and planning. Organization Address E-mail Position title Supervisor Type of Organization (Please check):

Tel Date of service: Public Service Industry Others (please specify):

Fax From
(mm/yy)

To
(mm/yy)

Teaching Trade

Research NGO

Please describe your work below.

Organization Address E-mail Position title Supervisor Type of Organization (Please check):

Tel Date of service: Public Service Industry Others (please specify):

Fax From
(mm/yy)

To
(mm/yy)

Teaching Trade

Research NGO

Please describe your work below.

Name:

Name: D. PROPOSED FELLOWSHIP 10. Objective and Description of Proposed activities: (Please attach additional pages of similar size if necessary.) a) Please state the objective of your Fellowship. What do you expect to accomplish during the proposed Fellowship in relation to tropical forestry and/or the timber industry sector?

b) State precisely what activities will be carried out.

Name: c) Please describe how your current work will benefit from the proposed fellowship and how you will apply the knowledge and skills acquired.

d) Indicate briefly the relevance of your proposed Fellowship activities to the objective and priority areas of the ITTO Fellowship Programme described in the information note.

e) Will the results of the proposed activity be published? If yes, please state additional information on the output.

Yes

No

Unknown

11.

Host Institution: Please write names of host Institutions and details of their participation and responsibility in the proposed Fellowship activities. If more than one location is listed, please indicate the period of time you will spend at each. Please seek approval from the institutions listed and attach a letter of acceptance or evidence of having initiated the admission process. Responsibilities Period of time

Name of Institution (City, Country)

12. Budget to finance proposed activities and contribution requested from ITTO: Please refer to the budget 6

Name: guidelines on the following page.

Items
Tuition/Training/Conference Fees:

Brief Description

Budget (US$)

Transportation Costs: a)Airfare (from to)

b) Surface Transport (from to)

Daily Subsistence Allowance (DSA): Please indicate City, Country and period of stay.

Book Allowance: Other Allowances: Please specify.

Total Amount: ITTO Contribution: Other Financial Sources: Please list any other financial sources and the amount secured or to be secured from the sources if your proposed activities require more than the maximum of US$10,000 and attach evidence of funding from the other financial sources. Please provide satisfactory proof if additional funding is provided from personal or family sources. Financial Sources Period Amount (US$)

Name:

Budget Guidelines: 1. The maximum amount for a fellowship award is US$10,000. 2. Allowable costs are: tuition/training /conference fees, transportation fees, daily subsistence allowance
(DSA), book allowance, and other allowances.

a) Tuition/Training/Conference Fees : Tuition/conference/training fees are allowed. However, the fees

for pre/post conference tours will be evaluated on a case-by-case basis.

b) Transportation Costs : The most direct economy class travel is allowed for international travel.
Internal travel is allowed when it is a part of proposed Fellowship activities.

c) Daily Subsistence Allowance : The DSA paid to a Fellowship awardee while he/she is outside his/her
home country or home/duty town is intended to cover the cost of the awardee's lodging, board and essential incidentals such as local transportation, etc. For activities lasting less than one month, the applicants governmental or organizational DSA rates would be applied. Stipend rates for U.N. Fellows and Scholars will be applied for activities lasting longer than one month.

d) Book Allowance : The Fellowship Programme provides US$100/month for the purchase of books and
software needed for the Fellowship activities for up to a maximum of 6 months.

e) Other Allowances : The maximum amount of other allowances is US$400. This includes the
following items:

i. Equipment Allowance : Minor equipment allowance related to proposed fellowship activities is

up to a maximum of US$100 upon presentation of supporting evidence.

ii.

Communication fees : A maximum of US$100 is allowed for communication fees only when proposed activities last longer than 1 month. on a case-by-case basis.

iii. Allowances for final report , visa and airport taxes: These allowances would be decided
Any other costs, such as fees associated with research and field work, would be approved only on a case-by-case basis. Please provide detailed budget information with an additional page if necessary.

3. The costs associated with the following items are not allowed:
a) Purchase of capital items, such as a computer, a printer, a camera, etc.; b) Personnel hiring and health insurance; c) Salaries for a Fellowship applicant or his/her assistant(s), honorarium for supervisors or institutional overhead; d) Thesis Allowance; e) Claims for typing of regular course assignments; f) Excess Baggage Allowance; and g) Warm Clothing Allowance.

4. Supporting documents providing tuition/training/conference fees and a written estimate of airfare issued by
a travel agent or an official source are required.

Name: E. ADDITIONAL INFORMATION 13. Is government clearance needed for your acceptance of this grant? If yes, please attach a copy of clearance. Yes No

14.

Two letters of recommendation are required for each applicant, using the attached form. Letters should be submitted to ITTO with the completed Fellowship Application Form by the applicant. Each letter should be signed and scanned if sent by e-mail. The letter should be signed and sealed in an envelope by the referee if sent by post. Please list name, position and address of your referees below. Referees Name Position Address

Referees Name Position Address

E-mail Tel Fax

E-mail Tel Fax

15. How did you first learn about the ITTO Fellowship Programme? (Please check with x.) Tropical Forest Update Tropical Timber Market Information ITTO Website University/Institution/Company Journal (Please specify the name.): Other (Please specify): Tropical Timber Market Information ITTO Website

Course Organizer

Government

F. APPLICANT CHECKLIST 16. Your application will not be considered if it is incomplete. Your application must be sent by e-mail or by post before the deadline, and must be typed or neatly written in block letters (printed). Please check with x the following list to confirm that your application is complete.
The deadline is met Application form enclosed Letter(s) of acceptance from participating institution(s) enclosed Documents showing airfare, such as a pro-forma invoice, enclosed, if traveling by air A certificate indicating proficiency in the language of study enclosed For short-term training courses and training internships: documents showing the course description and course fees enclosed For conferences: documents showing the conference description and fees, and an abstract of the paper or a full paper enclosed For study tours and lecture/demonstration tours: a detailed schedule of visit and pro-forma invoices for major costs enclosed For post-graduate studies: documents describing programme, tuition fees and other major costs, and a research proposal enclosed For technical document preparation: an outline or draft of the technical document and pro-forma invoices for printing and other major costs enclosed Typed or written in block letters (printed) in dark ink Two letters of recommendation enclosed

By my signature, I certify that all information provided is accurate. I understand that my application will not be considered if it is incomplete.

Signature: 9

Date:

Name:

International Organizations Center, 5F, Pacifico Yokohama, 1-1-1 Minato-Mirai, Nishi-ku, Yokohama 220-0012 JAPAN
Tel: +81-45-223-1110 Fax: +81-45-223-1111 e-mail: [email protected] Homepage: http://www.itto.int/

International Tropical Timber Organization Fellowship Programme

LETTER OF REFERENCE Applicant's Name:

(Family/Last Name) (First Name) (Middle Name)

Referee's name Title Organization Address Telephone Fax E-mail Please describe the applicant's professional strengths, work responsibilities, and outstanding achievements in tropical forestry and/or timber industry sectors. Indicate how long you have known the applicant and in what connection. Please describe how the proposed fellowship would enhance the applicants work.

Referees Signature:

Date:

Referees are requested to sign and scan this letter, if sent by e-mail, or enclose this letter in a signed/ sealed envelope, if application is sent by post. Letters should be submitted to ITTO with the completed Fellowship Application Form by the applicant.

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Name:

International Organizations Center, 5F, Pacifico Yokohama, 1-1-1 Minato-Mirai, Nishi-ku, Yokohama 220-0012 JAPAN
Tel: +81-45-223-1110 Fax: +81-45-223-1111 e-mail: [email protected] Homepage: http://www.itto.int/

International Tropical Timber Organization Fellowship Programme

LETTER OF REFERENCE Applicant's Name:

(Family/Last Name) (First Name) (Middle Name)

Referee's name Title Organization Address Telephone Fax E-mail Please describe the applicant's professional strengths, work responsibilities, and outstanding achievements in tropical forestry and/or timber industry sectors. Indicate how long you have known the applicant and in what connection. Please describe how the proposed fellowship would enhance the applicants work.

Referees Signature:

Date:

Referees are requested to sign and scan this letter, if sent by e-mail, or enclose this letter in a signed/ sealed envelope, if application is sent by post. Letters should be submitted to ITTO with the completed Fellowship Application Form by the applicant.

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