Application for the 2016 International Seminar on
Climate Change and Natural Resources Management
May 2 – 21, 2016
Application Form
Section 1 – Application Information
Surname (last name)
Given Name(s)
Please type your name as it appears on your Passport
Nickname
Date of Birth (day/month/year)
Male
Gender
Female
City of Birth
Country of Birth
Country of Citizenship
Country of Legal Permanent Residence
Work Information
Job Title
Work Phone Number
Institution/University/Organization
Alternate Phone Number
E-mail Address
Work Fax Number
Alternate E-mail address
Skype Address
Do you have reliable e-mail access?
Yes
No
Which is the best email to use to contact you regarding this program?
Work Address (Delivery Address for DHL/UPS/FedEx)
Please note: It is important that you provide an address suitable for use by a delivery service such as DHL, UPS or FedEx. Most international
delivery services will NOT deliver to a post office box. They usually require a road, highway or building complex address.
Organization:
Street Address:
City:
Province/State:
Postal Code:
Country:
Passport and Visa Information
Passport Number
Country of Issue
Date of Issue (day/month/year))
Date of Expiration (day/month/year)
1
Do you currently have a visa for entry into the United States?
Yes
If yes, what type of visa?
J-1
B-1
Other (please specify):
Visa Expiration Date (day/month/year):
Have you ever been to the United States before?
Yes
No
No
If yes, please list dates and visa type for each trip:
Have you ever been to the United States on a J-1 or J-2 Visa?
Yes
No
If yes, please list dates and visa category:
Emergency Contact in the United States
Surname (last name)
Relationship
First Name
Email Address
Phone Number
Section 2 – Sponsor Information
Do you currently have financing to attend this seminar?
Yes
No
If yes, please complete the sponsor information. If no, please indicate the source of funding you have applied for and indicate the date by which
you expect to have notification of funding. If available, include a copy of the approval notice of your funding with this application.
Sponsor Contact Name:
Sponsor Organization/Institution/University:
Sponsor Phone Number
Alternate Phone Number
Sponsor Fax Number
Sponsor E-Mail Address
Sponsor Address
Organization:
Street Address:
City:
Province/State:
Postal Code:
Country:
Date of funding award or notification:
Funding will cover (check all that apply):
Seminar Fee
International Travel
(Please note that the Seminar organizers do not provide scholarships or similar funding to support participants.)
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Section 3 – Additional Background
Please write a brief description of your current professional activities and job responsibilities.
What are the most critical climate change and natural resource management opportunities and/or challenges you
are facing?
How are you currently engaged (or plan to engage) in climate change and natural resource management-related
work?
Please rank which seminar theme is of most interest to you, on a scale of 1-6, with 1 indicating highest interest.
Impacts of Climate Change (What is happening?)
Adaptation & Mitigation Strategies for Natural Resource Impacts of Climate Change (What can we do about it?)
Institutional Responses to Climate Change (How will we do it?)
In addition to the foundational parts of our curriculum, we are interested in your preferences for additional topics.
Please rank the top three of the following topics according to your level of interest. Use a “1” for most interesting
to you, followed by “2” and “3”.
1
2
3
4
5
6
TOPICS
Forest Carbon – Measuring, Monitoring, Verification (includes REDD+)
Impacts to Water Resources – Floods and Drought
Data Management and Sharing, including GIS and Remote Sensing
Sea Level Rise, Coastal Dynamics and Fisheries
Human impacts, food security, community forestry
Grasslands, Rangelands, and Arid ecosystems
7
Governance – Coalition Building, Institutional Coordination, Climate Negotiations,
and Conflict Resolution
8
9
10
Communicating Climate Change - Challenges and Strategies
Extreme Climate Events, Disaster Planning, and Risk Management
Add your own:
RANK VOTE
What skills/knowledge do you hope to acquire during this seminar?
3
Please mark your proficiency in English for reading, writing, speaking and listening comprehension.
Fluent
Intermediate
Beginner
Reading
Writing
Speaking
Listening
Seminar policy requires shared accommodations throughout the 3-week Seminar. (Participants must pay an
additional $1,600 for a single room during the Seminar.) Are you willing to share a hotel room with another
participant (same gender) for the duration of the Seminar?
Yes
No
Are you comfortable walking 1-2 kilometers per day?
Yes
No
Are there other things you hope to gain from this experience or would like us to know?
Section 4 – Application Attachments
Please attach the following documents
Brief Resume
Photocopy or scan of passport information (and U.S. visa, if applicable)
To be fully consideration for participation, please send your completed application to
climateseminar@ucdavis.edu by January 18, 2016.
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