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Apply Now for the INEX Green.Building.Solutions. 2012
The deadline for application is the 15
th
May 2012.
Title
*
Mr.
Ms.
Salutation
Name
*
First
Last
Date of Birth
*
(mm/dd/yyyy)
Place of Birth
*
Nationality
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
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Bahrain
Bangladesh
Barbados
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Belize
Benin
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Bhutan
Bolivia
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Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
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Dominican Republic
East Timor
Ecuador
Egypt
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Equatorial Guinea
Eritrea
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Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
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Libya
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Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Northern Mariana Islands
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Phone/Mobile (including all area codes)
*
E-Mail address
*
secondary E-Mail address
University/Company
*
Field of Study/Expertise
*
Motivation
Change Maker Statement
*
Please describe your past experiences in the field and your motivation to participate in the program for delivering a positive impact to society.
I have heard about the program from
*
Make sure to mention here if you are in touch with an INEX Ambassador.
Languages
Please state the languages you speak and the level you possess. Important: You need to state at least two languages (e.g. English and your mother tongue, or if English is your mother tongue, at least beginner level in any other language)
Language 1
*
State of Language 1
*
Beginner
Intemediate
Advanced
Mother tongue
Language 2
*
State of Language 2
*
Beginner
Intemediate
Advanced
Mother tongue
Emergency Contact
Name
*
First
Last
Relationship
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Northern Mariana Islands
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Work phone/mobile (including all area codes)
*
Additional Information
Are you currently undergoing medical treatment for any reason?
*
Yes
No
Are you currently being treated by a psychologist or a physician for an emotional, nervous or mental disorder?
*
Yes
No
Are you currently taking prescription medication for an ongoing medical condition?
*
Yes
No
Do you have allergies, dietary restrictions or physical disabilities?
*
Yes
No
Do you have any documented learning disabilities?
*
Yes
No
Do you have any physical conditions that require special housing arrangements?
*
Yes
No
Have you ever been subject to disciplinary action that resulted in expulsion, suspension, probation or academic warning?
*
Yes
No
If you check "yes" on any of the questions above, please describe.
Documents
allowed file size: max. 2MB per file
Curriculum Vitae (*.doc, *.pdf)
*
Grade Transcript (*.pdf, *.jpg, *.jpeg)
In order to prove your student status please upload a recent grade transcript from your home university.
Photo (*.pdf, *.jpg, *.jpeg, *.gif)
*
Note: The image will be used for your ID card, the participants page and list, etc. Please use the 3x4 format.
Passport number
*
Passport expiration date
*
(mm/dd/yyyy)
Copy of your passport (*.pdf, *.jpg, *.jpeg)
*
Captcha
General Terms and Conditions
*
Accept
OeAD Wohnraumverwaltungs GmbH will be the contracting party for this program. By submitting your information through this online application form you start the application process for the program of your choice and agree to the INEX General Terms and Conditions (including the INEX Withdrawal or Deferral Refund policy). You also agree to have the photo uploaded through this form and the ones taken of you during the program used and published without restriction. Your personal data will be stored and processed.
Special Student Grant
we are in the process of contacting several firms and organizations to provide student grants for outstanding applicants in need of financial aid. If you feel entitled to this student grant, please check the box, we will contact you with further information.
I would like to be considered for a student grant (fill out the motivation statement below).
Please withdraw my application if I am not selected for the grant.
Motivation for special student grant
Please describe why you are eligible for a special student grant. Include details about your situation and your outstanding accomplishements.
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