International School of Nuclear Law, University of Montpellier 1 Photo (optional) Application for admission to the 2011 session We wish to welcome you and express our thanks for the interest you have shown in the International School of Nuclear Law. Only those applications which are fully completed in English or in French will be considered. Application forms should be completed electronically or typewritten where possible; otherwise please print legibly. Completed application forms must reach the Legal Affairs Section of the OECD Nuclear Energy Agency before 31 March 2011. For all inquiries concerning admissions, please contact: Legal Affairs OECD Nuclear Energy Agency Le Seine Saint-Germain 12, boulevard des Îles 92130 Issy-les-Moulineaux, France Tel: +33 (0)1 45 24 10 38 Fax: +33 (0)1 45 24 11 17 E-mail : isnl@oecd-nea.org Candidates are strongly advised to send their applications to the OECD Nuclear Energy Agency well in advance of the deadline to allow sufficient time to request any necessary clarifications. 1
I. PERSONAL DATA* Surname First name(s) Sex Nationality(ies) Date of birth Place of birth (City & country) Mother tongue Passport No. * Please ensure that your first name and surname (i.e. family name) appear exactly as they are indicated on your passport or National Identity Card (for French nationals only). Also double-check that the information under the sections date and place of birth and Passport No. is correct. BUSINESS ADDRESS (where applicable) Street/Number City (including postal code) Country E-mail Telephone (incl. country code) + Fax (incl. country code) + PERSONAL ADDRESS Street/Number City (including postal code) Country Telephone (incl. country code) E-mail Fax (incl. country code) II. ACADEMIC AND PROFESSIONAL RECORD Languages Complete the table below indicating your degree of proficiency in English and French by using the following symbol: M = mother tongue, A = good, B = average, C = elementary, D = none. English Reading Comprehension Speaking Writing Degrees, diplomas if any (exact title) French 2
Previous studies List your studies in chronological order, starting with the most recent, up to and including secondary school; for university studies, indicate also the relevant Faculties or Departments. Name, place and country of institution Dates attended Degrees (exact titles) Degrees From To Received Expected List, in order of importance, the main subjects you studied at university. 3
Professional and other activities, starting with current activity. Position held Description of employment or activity Name and address of employer or organisation From Dates To III. THESES, DISSERTATIONS AND PUBLICATIONS Please provide all relevant information (subject, dates of writing or publication, publisher, number of pages, etc.). IV. REFEREES Please include the name, title, contact address, telephone and fax numbers, and email address if possible of a person, not related to you, who is familiar with your academic or professional work. 4
V. REASONS FOR WISHING TO TAKE PART IN THE INTERNATIONAL SCHOOL OF NUCLEAR LAW PROGRAMME (you may attach an extra page if necessary) VI. FINANCIAL SUPPORT The NEA awards grants to students from amongst its member countries qualified to participate in this programme. If your participation is conditional upon being financially supported by the NEA, please check here. The IAEA awards grants to professionals from amongst its member states. If your participation is conditional upon being financially supported by the IAEA, please check here. Note: It is solely the IAEA s decision/discretion to support candidates which is why you must finalise the IAEA application process under its technical assistance programme at the same time. Your application for the ISNL will not be considered until we have been informed by the IAEA that the application for a grant is completed. For further information on IAEA financial assistance, send an e-mail to: OLA- ISNL.Contact-Point@iaea.org. VII. DIPLOMA IN INTERNATIONAL NUCLEAR LAW It is possible for participants in this programme to apply for a Diploma in International Nuclear Law. This Diploma is awarded on the basis of active participation in classes, upon successful completion of a written examination and submission of a dissertation on international nuclear law. Would you be interested in applying for such a Diploma? Note: Participants benefiting from an NEA or IAEA grant must apply for the Diploma. Yes, I am interested in applying for the Diploma in International Nuclear Law. 5
VIII. INSURANCE Participation is conditional on accepting the following conditions: I will obtain insurance covering illness, hospitalisation and repatriation during the whole period of my stay in the International School of Nuclear Law. I accept that the University of Montpellier 1 and the OECD Nuclear Energy Agency decline any responsibility in the event of accident or illness occurring during this period of time. Legal notice: Participants who cancel their participation in the programme after 22 July 2011 will be liable for the payment of registration fees and for the costs of accommodation arranged by the ISNL on their behalf, except in cases of medically certified illness or injury. SIGNATURE The undersigned certifies that the statements made on this application form are complete and true. Place and date Signature 6