SEAMEO REGIONAL CENTRE FOR ARCHAEOLOGY AND FINE …
Fundamentals of the Conservation of Photographs
Application form
----------------------------------------------------------------------------
To be filled out by prospective participant. Please note that this application requires the signature of an institutional director where applicable. This form may be reproduced.
Course Title: Fundamentals of the Conservation of Photographs
Module 1
Dates: Summer School: 21 July -15 August, 2008 Distance Learning Phase: September 2008-April 2009
Venue: Academy of Fine Arts and Design (AFAD), Bratislava;
Slovak National Museum (SNL), Martin
Slovak Republic
Application deadline: 11 April, 2008
Submit applications to: photoconscourse@getty.edu
Please fill out this form and submit it electronically to the e-mail address above.
1. type in the grey fields, save your application to your computer and e-mail it to the address above OR 2. print the application, complete and scan it and email it to the address above.
|insert recent |
|photograph in jpg format (or |
|attach separately) |
FROM:
Country
PERSONAL INFORMATION
1. Name in Full:
(last name) (first name)
2. Academic or Professional Title:
(Please indicate appropriate title i.e., Dr., Prof., or simply Mr. or Ms.)
3. Professional designation:
(i.e. Archivist, Conservator, Curator, Collections Manager, etc.)
4. Name of Institution:
5. Office address:
| |
6. Office phone: Office fax:
| |
7. Mailing Address:
8. Phone: Fax:
9. Email: Mobile phone:
10. Name and Address of Person to Contact in Case of Emergency :
| |
Tel No.: Fax No.:
PROFESSIONAL INFORMATION
1. Education
1.1 Colleges/Universities Attended:
|Name of College/ |From |To |Major Subjects/ Fields of Study |Diploma/ |
|University and Country | | | |Degree |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
2. Experience and Background
1. Employment History (in chronological order):
|Position |Name of Institution/Employer |From |To |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
2. Duties and Responsibilities (Brief description of the applicant’s most recent job.) Please feel free to continue in section 4. at the end of this document should you require more space.
| |
3. Specialization (Description of the applicant’s major areas of professional interest)
| |
2.4 Training and Professional Development. Please list any courses, workshops, fellowships or internships you have attended which are related to conservation and/or photography
|Name of Training Course/ Workshop |Venue and Instructor |From |To |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
2.5 Conferences Attended
|Name and Location of Conference |Presenter or Participant? |Date |
| |(if Presenter, title of paper) | |
| | | |
| | | |
| | | |
| | | |
| | | |
2.6 Research Work and Publications. Please feel free to continue in section 4. at the end of this document should you require more space.
|Nature of Research or Publication |Publisher or Source |Date |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
2.8 Language Proficiency.
(Please indicate EXCELLENT, GOOD or FAIR for each language listed)
|Language |Speaking |Reading |Writing |
|English | | | |
|1st Language (mother tongue): | | | |
| | | | |
|Other Languages: | | | |
| | | | |
| | | | |
2.9 Computer Skills
(Please list which computer programs the applicant knows and uses)
| |
| |
| |
| |
| |
| |
3. Course Expenses
3.1 Will you or your institution be able to cover the cost of travel to and from the Slovak Republic and daily expenses (not including accomodation) during the course?
Yes No
4. Personal Statement
Briefly explain: 1) Why you are applying for this course; 2) what you hope to learn from this activity; and 3) how this course will benefit your current/future employer(s) or institution(s). Please feel free to continue in section 4. at the end of this document should you require more space.
| |
5. Additional writing space
If you did not have enough space to complete any of the sections, please use this space to add any additional information. Please indicate the section number before your comments.
| |
TERMS OF PARTICIPATION AGREEMENT
I hereby confirm my interest to participate in first module of the course Fundamentals of the Conservation of Photographs. This module includes a summer school from 21 July – 15 August 2008 and also includes distance learning activities which I will undertake at my own institution during the period of September 2008 – April 2009.
If selected as an official participant, I agree to join the course in its entirety, participate actively in all sessions and cooperate with the GCI, AFAD and SNL to ensure the success of the course.
I understand and accept that my participation is covered and governed by the stipulations and provisions set forth in the disseminated course information.
I certify to the veracity and accuracy of information provided in this registration form and waive GCI, AFAD and SNL of all responsibility and accountability for any untoward incident that may happen to my person during the course beyond the control of the course organizers.
Date Signature of Applicant
Name and Title of Director/Supervisor
Date Signature of Director/Supervisor
Please insert an electronic signature OR
print this document, sign it, scan it and e-mail it
as an attachment.
-----------------------
[pic] [pic] [pic]
[pic] [pic] [pic]
[pic] [pic] [pic]
[pic] [pic] [pic]
[pic] [pic] [pic]
[pic] [pic] [pic]
[pic] [pic] [pic]
[pic] [pic] [pic]
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.