Swedish National Course in Philosophy of Computer Science

COURSE APPLICATION FORM

Return completed form to

gordana.dodig-crnkovic@mdh.se
http://www.idt.mdh.se/~gdc/

Please tell us how you became aware of this course

�        Web-site

�        Personal invitation

�        Other (please specify)

1.    COURSE

CLOSING DATE FOR APPLICATIONS IS  JANUARY 20^st 2004

2.    PERSONAL DETAILS

Title (Mr/Mrs/Miss/Ms/Dr):

Surname/Family Name:

Forename(s):

Address for Correspondence:

Daytime Telephone Number:

Please let us know of any special requirements we should put in place to ensure that you can access the course:

3.    EMPLOYMENT DETAILS

Position:

Name and Address of Employer:

Telephone Number:

4.    EXPERIENCE AND QUALIFICATIONS

Please give brief details of your research interests:

To help us prepare for the course, it would be useful to have brief details of any research experience you may have (whether or not related to the topic of the course):

Please list your educational and any professional qualifications here, with dates:

5.    FINANCIAL DETAILS

The participation in the course is free of charge.

Refreshments are included, but not lunch (available on campus).

Please indicate how the cost of you attending the course will be funded

�        Funded by employer

�        Self-funded

�        Other (please specify)