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Application Form - Training Workshop on Computer Science Education (Kuala Lumpur, Malaysia - 1st-5th July 2019)
Closing Date of Application: 31 May 2019
Full Name *
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Designation *
Gender
Nationality *
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Passport Number / IC No. *
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Date of Birth
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Applicant's Office Address *
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Office Phone Number *
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Office Fax Number
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Mobile Number *
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Official E-Mail *
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Personal E-mail
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Person to be contacted in case of emergency (Name, Address and Phone) *
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Education - Name of institution *
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Major field of study / Degree *
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Year of study
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Other Degrees
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Employment Record - Current Post / Title of Post *
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Duration of service
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Name of immediate supervisor and title of post *
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E-mail of immediate supervisor *
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Type of organization *
Total Number of employees in organization
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Description of your current work including your responsibility (100 words)
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Reasons for applying (100 words)
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Have you previously participated in any ISTIC programme?
If yes (Name of programme and date)
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English Language Proficiency - Listening
English Language Proficiency - Speaking
English Language Proficiency - Writing
English Language Proficiency - Reading
Name of Head of Organization *
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Address of Organization *
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Head of Organization - Phone Number
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Head of Organization - Fax Number
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Head of Organization - E-mail *
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Declaration - Have you ever been convicted by a Court of Law of any country? *
If Yes, Please give brief details
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I (applicant) certify that my statements in answer to the foregoing question are true, complete and correct to the best of my knowledge and belief. I fully understand that if I am granted an award it maybe subsequently withdrawn if I fail to make adequate progress or for other sufficient cause determined by the host government. *
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