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Proyecto DIRMAPA- Diálogo Regional sobre Manejo Ambiental y de Recursos Naturales en los Países
Andinos 2013-2014
1. Título del curso/ taller
Curso Regional semi presencial “Diálogo e interculturalidad en contextos de conflictos
vinculados a la gestión de los recursos naturales”
Fase Virtual: 5 de agosto al 13 setiembre 2013
Fase Presencial: 1 al 5 de octubre del 2013
2. Apellidos:
3. Nombres :
4. Sexo:
Estado civil :
5. Nacionalidad:
No. de documento de identidad:
6. Área geográfica del trabajo profesional:
7. Fecha, lugar y país de nacimiento:
8. Dirección privada
Calle//Av.
Ciudad
País
Teléfono (Código país/ Código ciudad/ No. de teléfono)
E-Mail
9. Dirección laboral
Nombre Empresa/ Organización
Calle/ Casilla postal
Código Postal, Ciudad
País
Teléfono (Código país/ Código ciudad/ No de teléfono)
E-Mail
Página Web
10. Profesión:
11. Cargo / Área en la que labora:
Inserte aquí su
foto
Kompetenzcenter Regionale HCD-Programme
Lateinamerika/ Karibik 25A0
FORMULARIO DE SOLICITUD
Deberá ser llenado con mayúsculas por el
Solicitante*
A
12. ¿Cómo vas a aplicar los conocimientos y experiencias adquiridos durante el curso en su trabajo profesional?
Por medio de la presente hago constar que
- mis datos consignados en este formulario son verdaderos,
completos y correctos.
En caso de obtener una beca de perfeccionamiento, me
comprometo a
-- aceptar el reglamento del curso
--------------------------------------------------
Fecha / Lugar
----------------------------------------------------
Firma del solicitante

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Formulario de Aplicacion al Curso

  • 1. Proyecto DIRMAPA- Diálogo Regional sobre Manejo Ambiental y de Recursos Naturales en los Países Andinos 2013-2014 1. Título del curso/ taller Curso Regional semi presencial “Diálogo e interculturalidad en contextos de conflictos vinculados a la gestión de los recursos naturales” Fase Virtual: 5 de agosto al 13 setiembre 2013 Fase Presencial: 1 al 5 de octubre del 2013 2. Apellidos: 3. Nombres : 4. Sexo: Estado civil : 5. Nacionalidad: No. de documento de identidad: 6. Área geográfica del trabajo profesional: 7. Fecha, lugar y país de nacimiento: 8. Dirección privada Calle//Av. Ciudad País Teléfono (Código país/ Código ciudad/ No. de teléfono) E-Mail 9. Dirección laboral Nombre Empresa/ Organización Calle/ Casilla postal Código Postal, Ciudad País Teléfono (Código país/ Código ciudad/ No de teléfono) E-Mail Página Web 10. Profesión: 11. Cargo / Área en la que labora: Inserte aquí su foto Kompetenzcenter Regionale HCD-Programme Lateinamerika/ Karibik 25A0 FORMULARIO DE SOLICITUD Deberá ser llenado con mayúsculas por el Solicitante* A
  • 2. 12. ¿Cómo vas a aplicar los conocimientos y experiencias adquiridos durante el curso en su trabajo profesional? Por medio de la presente hago constar que - mis datos consignados en este formulario son verdaderos, completos y correctos. En caso de obtener una beca de perfeccionamiento, me comprometo a -- aceptar el reglamento del curso -------------------------------------------------- Fecha / Lugar ---------------------------------------------------- Firma del solicitante