ࡱ > | ~ y z { '` 0 bjbjLULU < .? .? , , , , , , , @ J J J 8 J dK < @ I ` M M M M M O O O t v v v v v v $ h x i , V O O V V , , M M T Y Y Y V , M , M t Y V t Y Y x 0 , , M M %$n` J V X $ H , 0 I ̀ @ V H , < O 0Q Y R 4 S 5 O O O X O O O I V V V V @ @ @ 3 9 @ @ @ 9 @ @ @ , , , , , , Ritsumeikan University, Research Center for Disaster Mitigation of Urban Cultural Heritage
UNESCO Chair Program on Cultural Heritage and Risk Management
International Training Course on
Disaster Risk Management of Cultural Heritage 2011
APPLICATION FORM
Please complete this form in full, by computer.
CANDIDATE
Family Name
First Name
PhotographDate of Birth: D/M/Y
Age
Nationality
Place of Birth
Expertise
( ) Cultural Heritage Field
( ) Disaster Management FieldGender
( ) Male
( ) FemaleIn which region is your country located? (eg; east Asia)
What are main disaster risks in your area? (eg; earthquake and fire)
Institution/Business Name and Address
Web Site Address of Institution / Business (If available)
Current Professional Position
Office Phone No. (+ Country Code)
Office Fax No.
Email Address
Ģý Address
Ģý Phone No. (+ Country Code)
Ģý Fax No.
Mobile (Cell) Phone No.
Please list any food you cannot eat due to allergy problem or religious reasons
EDUCATIONAL BACKGROUND
Academic Qualifications
Full Name of Institution and CountryDuration (from - to)Degree Obtained
Relevant Professional Courses
Full Name of Institution and CountryDuration (from - to)Degree Obtained
PUBLICATIONS AND RESEARCH
List your significant publications (title, publisher and date) and/or research projects
TitlePublisherDate
ENGLISH LANGUAGE ABILITY
Please rate your language proficiency from Excellent to Poor
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PROFESSIONAL ACTIVITIES
Describe your current responsibilities and professional activities
Relevant Previous ActivitiesDates (from - to)Responsibilities
PERSONAL STATEMENT
Explain why you are applying for this course, what you hope to learn from it, and how it will benefit your own professional development and that of your institution.
Name of the Cultural Heritage Site for which a risk management plan will be formulated:
Is this a World Heritage Site?( ) yes( ) no
Reason for Selecting the above Cultural Heritage Site:
Ritsumeikan University, Research Center for Disaster Mitigation of Urban Cultural Heritage
UNESCO Chair Program on Cultural Heritage and Risk Management
International Training Course on
Disaster Risk Management of Cultural Heritage 2011
Short paper 0d e s c r i b i n g p r o j e c t ( s ) o r p r o g r a m m e c o n c e r n i n g c u l t u r a l h e r i t a g e c o n s e r v a t i o n a n d m a n a g e m e n t o r d i s a s t e r r i s k m a n a g e m e n t i n w h i c h y o u h a v e b e e n i n v o l v e d , a n d y o u r o v e r a l l p o t e n t i a l f o r s u c c e s s i n f u r t h e r a p p l y i n g t h e c o u r s e c o n t e n t s i n y o u r p r o f e s s i o n a l c a reer.
Ritsumeikan University, Research Center for Disaster Mitigation of Urban Cultural Heritage
UNESCO Chair Program on Cultural Heritage and Risk Management
International Training Course on
Disaster Risk Management of Cultural Heritage 2011
QUESTIONNAIRE
As part of our commitment to provide high quality training course, we would appreciate your honest and constructive expectations from this course. All comments will, of course, be treated strictly confidential.
Q1. Where did you know this trai n i n g c o u r s e ?
%A F r o m D M U C H o r R i s t u m e i k a n U n i v e r s i t y w e b s i t e %B F r o m o t h e r w e b s i t e s s u c h a s U N E S C O W o r l d H e r i t a g e C e n t r e , I C C R O M o r A s i a n A c a d e m y %C F r o m m y c o l l e a g u e s o r f r i e n d s %D O t h e r ! P l e a s e d e s c r i b e b r i e f l y .
Q 2 . W h a t e x p e c t a t i o n s d o y o u h a v e d u r i n g t h i s t r a i n i n g c o u r s e ?
%A I w a n t t o k n o w t e c h n i q u e s a n d p o l i c i e s o f D i s a s t e r R i s k M a n a g e m e n t f o r C u l t u r a l H e r i t a g e i n c a s e o f J a p a n . %B I w a n t t o s h a r e t h e k n o w l e d g e a n d e x p e r i e n c e w i t h t h e o t h e r p a r t i c i p a n t s a n d r e s o u r c e p e r s o n s , a n d b e p a r t o f t h e i n t e r n a t i o n a l n e t w o r k . %C O t h e r ! P l e a s e d e s c r i b e b r i e f l y .
Q 3 . W h a t p l a n d o y o u h a v e a f t e r t h i s t r a i n i n g c o u r s e ?
%A I w i l l s h a r e t h e k n o w l e d g e a n d e x p e r i e n c e w i t h m y c o l l e a g u e s . %B I w i l l o r g a n i z e a t r a i n i n g b a s e d o n t h e e x p e r i e n c e a n d k n o w l e d g e g a i n e d f r o m t h i s t r a i n i n g c o u r s e i n J a p a n . %C I w i l l p r o p o s e t h e C u l t u r a l H e r i t a g e R i s k M a n a g e m e n t p l a n f o r a p a r t i c u l a r h e r i t a g e s i t e i n m y c o u n t r y . %D O t h e r ! P l e a s e d e s c r i b e b r i e f l y .
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l a yt& rban Cultural Heritage
UNESCO Chair Program on Cultural Heritage and Risk Management
International Training Course on
Disaster Risk Management of Cultural Heritage 2011
OFFICIAL ENDORSEMENT
Your application will not be considered unless this section is correctly filled in by the person endorsing the application (public official, employer, or academic supervisor). The undersigned:
Only this page please E-mailed us in PDF file.
Name
Title or Position
Institution or Organization
Address
Phone No. (+ Country Code)
Fax No.
Email Address
endorses the application of the candidate:
Name
Will the candidate's present position still be available to him/her after the course is over?( ) yes( ) noSignature of the person endorsing the application
Date
Stamp of Institution
CANDIDATES STATEMENT
I declare that the above information is true and correct. I also declare that, to the best of my knowledge, my health allows me to undertake the proposed training program.
Candidates Signature
Date
Rits-DMUCH
Research Center for Disaster Mitigation of Urban Cultural Heritage,
Ritsumeikan University, Kyoto, Japan
PAGE \* MERGEFORMAT 1
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