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Yellow Pages Experts Form
1. Personal & Mail Information
Last Name:
First Name:
Address:
Best Mail Address:
Other Mail Address:
City:
Country:
Postal Code:
Telephone:
Fax:
E-Mail:
Birthday:
Language(s):
2. Higher Education background
Degree:
Year:
University:
Subject/Major:
Other Degree:
Year:
University:
Subject/Major:
Other Degrees:
3. Experience background
Program in which engaged at present:
Since:
Type of Institution:
Present Main Job:
Institution's Name:
Address:
Address (continuation)
Tel:
Fax:
E-Mail:

Other Previous Jobs/Experience:
Since:
Type of Institution:
Institution's Name:
Address:
Address (continuation)
Tel:
Fax:
E-Mail:
4. Your time distribution
Research:	(%)
Teaching:	(%)
Consultancy:	(%)
Administration:	(%)
Studying:	(%)
Other (Specify):	(%)
5. Your areas of expertise
Primary area:
Sub-Areas:
1.
2.
3.

Secondary area:
Sub-Areas:
1
2
3

Asfa Code (s):
6. Your ties with IOCARIBE:
If you belong to any group of experts of IOCARIBE, please fill in the name(s):
Experts Group:
Experts Group:
7. Your currently running projects in the IOCARIBE geographic area.
Please replicate the same information for up to your main three (3) projects, if applicable.
1. Name of Project:
Subject:
Discipline(s):
Summary Goals:
Place/Area:
Dates:	Start: End:
Sponsored/Funded by:
Your Participation/Job/Responsibility:
Percentage of your time:

2. Name of Project:
Subject:
Discipline(s):
Summary Goals:
Place/Area:
Dates:	Start: End:
Sponsored/Funded by:
Your Participation/Job/Responsibility:
Percentage of your time:

3. Name of Project:
Subject:
Discipline(s):
Summary Goals:
Place/Area:
Dates:	Start: End:
Sponsored/Funded by:
Your Participation/Job/Responsibility:
Percentage of your time: