INET '93 Developing Countries Network Training Workshop Application for Admission Name: Address: Employer: Telephone: Telex: Fax: Electronic mail address (if any): Nationality: Knowledge of English: __ Track applied for: |__| Basic technical track (check one) __ |__| Advanced technical track __ |__| Network services track 1. Please summarize your educational background and relate your training to the prerequisites for the track you would like to attend. 2. Please describe your current job and duties and how they relate to data networking activities in your country. 3. Please describe how you expect to implement the knowledge you gain through attendance at the workshop and conference(s) upon your return to your country. Do you anticipate any change in your position or duties when you return as a result of your participation in these events? 4. If you are requesting financial aid from INET '93 for attending the workshop and conference, please provide an itemized expenditure budget for your travel and expenses. Please also provide an income budget containing sources of income that are available to you for attending. Please include with your application a signed statement from the head of your institution stating that no additional funds (beyond those included in your income budget) are available to you for the purpose of undertaking this travel and participating in this training and conference activity. 5. Please describe any issues or circumstances that would affect your participation in the workshop, e.g. physical disabilities, medical conditions, or dietary restrictions. Signature: ________________________________ Date: _________________ Please return this application to: Mail: INET '93 Developing Countries Workshop c/o USRA 625 Ellis Street, Suite 205 Mountain View, California 94043 U.S.A. Voice: 1.415.390.0317 Facsimile: 1.415.390.0318 Telex: 235128 NYU UR (Attention: INET '93 Developing Countries Workshop) Applications may be submitted electronically by sending electronic mail to: workshop-request@inet93.stanford.edu ====================================================================== George Sadowsky, Director Phone: (212) 998-3040 Academic Computing Facility Fax: (212) 995-4120 New York University Telex: 235128 NYU UR 251 Mercer Street Bitnet: sadowsky@nyuacf New York, New York 10012-1185 Internet: sadowsky@nyu.edu