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ITU Telecom World 2009 - Application

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ITU Telecom World 2009 - Application Powered By Docstoc
					                                 ITU T ELECOM W ORLD 2009                              TWO RECENT
                                                                                       PHOTOGRAPHS
                          FELLOWSHIP NOMINATION FORM                                        TO BE
                                                                                      ATTACHED HERE
                              WORLD 2009 YOUTH FORUM
                                   APPLICANTS
Please return to:   Ms Tsehai Bekele                                          Tel:   +41 22 730 5179
                    Project Officer, TDS & Youth Forum                        E-mail: sunny.bekele@itu.int
                    Places des Nations
                    1211 Genève 20, Switzerland

   (PLEASE SEND THIS NOMINATION FORM ORIGINAL BY POSTAL SERVICES WITH THE PHOTOGRAPH AND
                            COPY VIA E-MAIL TO: sunny.bekele@itu.int)

                           (PLEASE PRINT IN CAPITAL LETTERS)
The Government of PORTUGAL nomi nates the followi ng candidat e f or an ITU Fellow ship
to attend the ITU TELECOM WORLD 200 9 YOUTH FORUM in Geneva, 5 to 9 October
2009).
Candidate’s Personal History:

Family name: Ms/Mr _____________________________ First name: _____________________________

Date of Birth: ________________________________            Nationality: _____________________________

Major field of study: Telecommunications

Name of current university/technical institution and place of study: IST – Technical University of Lisbon,
Lisbon, Portugal

Complete address of current university/technical institution: IST, Av. Rovisco Pais, P-1049-001, Lisbon,
Portugal

Telephone: ________________________ Fax: ____________________ E-mail: ______________________

Private Mailing address:
________________________________________________________________________
________________________________________________________________________
__________________________________________________________________

Telephone: _____________________ Fax: ____________________ E-mail: ________________________

Please write an essay on the following question (see page 3)



Signature of fellowship candidate: __________________________________________________________________


Date & Place: ____________________________________________________________________________________
CONDITIONS: Fellowships are awarded under the following conditions:
1. Fellowships will be granted for one young man and one young woman who have completed two
   years of university or technical institution and are between 18 and 23 years of age by 30 June 2009.
2. Submitted essay (see page 3) chosen by Official Selection Panel
3. Candidatures must be received by the ITU by 27 March 2009.
4. It is imperative that the youth fellow be present for the duration of the Youth Forum (4 to 9 October 2009),
   participate during the entire duration of the event and abide by the rules and regulations as set forth
   by the organizers of the event.


     University recommendation: This candidate would benefit from the Youth Forum because:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
         ______________________________________________________________


I confirm that this candidate may be absent from his/her studies for the duration of the Forum award.


Name of person
signing for
University
President/Dean:

Telephone: ___________________________________ Fax: ____________________________________

E-mail: ______________________________________



To validate this fellowship request, name and signature of certifying government official designating
participant must be completed below with official government stamp:

Name of Certifying Government Official                                 Signature



______________________________                              ________________________________



                                                  STAMP




                                                                                                           2
                ESSAY: 250 - 500 WORDS

Please submit your essay in one of the following languages:
   (English, French, Spanish, Russian, Arabic, Chinese)

"WHAT IS THE BIGGEST PROBLEM IN YOUR COMMUNITY AND HOW
WOULD YOU USE INFORMATION COMMUNICATION TECHNOLOGIES
                      TO SOLVE IT?"




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posted:9/22/2011
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