prescribed proforma. bio-data may also be furnished to undersigned

File No.U-l I 01 2 11 31201 4-lC

F. No. U-1 1 01 2/1 31201 4-lCGorernment of lndia

Ministry of Rural DerelopmentDepartment of Rural De\elopment

(lC Section)

Krishi Bhawan, New Delhi

dated 20th May, 2016

To

The State Secretaries of Rural Dewlopm ent (ln charge)

S ubject: Training Programme on "Vegetables: From Seed to Table and Beyond" AVRDC- TheWorld Vegetable Centre, Bangkok, Thailand, September- November 2016

Sir,

lam directed to enclose a copyof MRDO'S letter no. Secretary General, MRDO Mde its letterno. CB/TRG/AVRDC|2016 dated 03rd lvlay,2016 on the subject mentioned above and to saythatthenom ination of willing and eligible candidate(s ) for the aforesaid training program m e duly com pletedin all respect and forwarded by the concerned authorities, may be sent to the lC Division in theprescribed proforma. Bio-data may also be furnished to undersigned and it may be emailto icsection.mord@gm ail.com as per closing dates gi\en below:

Programme Duration Closing date forNominations toreach MoRD

Closing date forNominations toreach AARDO

Module I

From Seed to Han/est 05 - 30 Sept. 2016 05 Ju ly 201 6 15 July 2016Module ll

From Han€st to Table 03 - 28 Oct. 2016 25 Ju ly 201 6 31 July 2016Module lll

Sustainable Derelopm ent 31 Oct. - 25 Nov2016

25 July 2016 3'1 July 2016

Encl: as above.

fa ithfu lly,

12

(Priya Rariian)Directorl(lC)

Te|.23382860

Copy to:

1. Director General, NIRD & PR, Rajendra Nagar, Hyderabad.2. Director of all SlRDs. (through E-mail).3. Principals of all ETCs- (through E-mail).4. Director (NlC): For uploading on the website of the Ministryand Diksha Portal.

East and Southeast Asia P.O. Box 1010 (Kasetsart University) Bangkok 10903, Thailand Tel: +66-2-942-8686 Fax: +66-2-942-8688 Web: www.avrdc.org Email: [email protected]

APPLICATION FORM

International Vegetable Training Course

“Vegetables: From Seed to Table and Beyond”

AVRDC Research and Training Station

Kasetsart University, Kamphaengsaen Campus

Nakhon Pathom, Thailand

PERSONAL INFORMATION (Kindly print legibly. The information provided below must match those indicated in

your passport). Attach scanned copies of Pass Port.

(PARTICULARS MUST BE TYPED/PRINTED)

Given Name

Middle Name

Family Name

Nationality Date of Birth

(dd/mm/yyyy)

Place of Birth

Passport

Number

Date and Place of

Issue

Date of Expiry

Sex

Marital Status

Office Name

(Employer)

Office Address

Home Address

Tel (O): Fax (O): E-mail (O):

Tel (H): Fax (H): E-mail (H):

EDUCATIONAL BACKGROUND (last two institutions only)

Name of Institution/location Degree Years Attended

From To

Photograph


Have you attended previous AVRDC Training Courses? _____ YES ____ NO

If yes, please indicate the year: _______

EMPLOYMENT/EXPERIENCE

Present

job/position

Main

responsibilities

Previous job(s)/position Office, location

Years of Service

From To

ENGLISH PROFICIENCY:

Since the course language will be English, a certain level of English proficiency in written and oral form is required to

fully benefit from the course. Please tick your level of proficiency below:

Test of English as a Foreign Language (TOEFL): _____ score for paper based test; _____ score for a computer-

based; ____ score for internet-based test.

International English Language Testing Service (IELTS): _____ score

Completed university education where the subject English comprised the main component of the course of study.

Other proof of English proficiency, please specify:

FINANCIAL SUPPORT1

Personal

Donor funded

Sponsoring agency:

Contact person in

sponsoring agency:

Contact details:

(Phone/Fax/Email)

I am interested to join the training but do not have any financial means to participate.

1 Please note that AVRDC does not provide scholarships for the 33

rd IVTC.


Which module(s) would you like to attend for this training? Please tick.

Module I: “From Seed to Harvest”, 15 September to 10 October 2014

Module II: “From Harvest to Table”, 13 October to 7 November 2014

Module III: “Vegetables for Sustainable Development”, 10 November to 5 December 2014

Food restriction: I am strictly vegetarian I cannot eat beef I cannot eat pork

I cannot eat _______________________________________________________

CONTACT INFORMATION (Person to contact in case of emergency)

Name

Relation

Address

Contact details

(phone/fax/email)


YOUR MOTIVATION

Please state briefly the reason for applying to this training course, your main field of interest within the training course

and how you hope to benefit from the training course (no more than one page).


ASSURANCE OF POSITION STATEMENT

Place: _________________________

Date: _________________________

To:

AVRDC – The Word Vegetable Center

Regional Office East and Southeast Asia

P.O. Box 1010 (Kasetsart University)

Bangkok 10903, Thailand

This is to assure that ___________________________________ who currently holds the position of

(Name)

__________________________________________________________________________________

(Position)

at the _____________________________________________________________________________

(Organization)

in ___________________________________________ will be granted leave of absence and will be

(City/Country)

assigned to the position of

___________________________________________________________________________

(Position)

at the termination of the advanced training, should he/she be selected.

Name: ________________________________

Signature: ________________________________

Title of position:________________________________

Official address: ________________________________

________________________________


________________________________

prescribed proforma. bio-data may also be furnished to undersigned

Documents