This document is an application form for a course on innovation teaching/facilitating. It requests personal information like name, gender, nationality, job details, qualifications, and English proficiency. It asks about the applicant's motivation to attend, how they will use what they learn, and their experience in innovation or teaching. The applicant must confirm they can pay for travel and hotels, and attend all dates for the course cycle they select. To complete the application, the applicant needs to upload their CV.

1. 1
APPLICATION FORM
Course title:
Date & place:
A. Personal information
Last name: ……………………………………………………………………………………………………......
First name: ………………………………………………………………………………………………………...
Gender: □ Male □ Female
Date of birth: ...…………………………………………………………………………………………………..
Please write down the day, month, year –not in a numeric format.
Nationality: …………………………………………………………………………………………………………
Country of residence: …………………………………………………………………………………………
Job title:…………………
Organisation:…………….
Postal address: …………………………………………………………………………………………… .…
…………………………………………………………………………………………………………………………..
Country: …………………………………………………………………………………………………………….
Phone number (incl. country code): …………………………………………………………………....
Email address : …………………………………………………………………………………………………
B. Qualification
Pos t-Graduation years of work experience
……..... ye a rs
Academic/Professional Qualification (3 most recent)
Qual ification Ins titution Year of Completion Final Result
1.
2.
3.
Your level of proficiency in English □ Beginner
□ Intermediate
□ Advanced
□ Fluent/Mother tongue

2. 2
C. Motivation and Expectations
1. Please briefly outline the motivation to attend the course
2. How do you expect to utilise the knowledge and experience gained from the course?
3. Please describe your experience and involvement in the field of Innovation teaching/facilitating
D. Other
How did you find out about this course?
 Climate-KIC website
 Regional Climate-KIC announcements
 University notice
 Notice by employer
 Other website
 Social Media
 Word of Mouth
 Other, please specify below
You may tick more than one answer.
If you ticked "other", please specify:
In order to process your application, please provide us with the following documents:
- Curriculum vitae (upload)
Please confirm
that you can pay for your travel and hotel (all other costs such as course rooms, materials and
speakers, lunch & dinner will be covered by Climate-KIC): □ yes □ no
and can attend all the dates: □ Cycle 1; □ Cycle 2; □ Cycle 3; □ Cycle 4