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INTERNATIONAL MONETARY FUND-MIDDLE EAST CENTER FOR ECONOMICS AND FINANCE CEF - Nomination Form Nomination Deadline Course Name Principal Nominee Alternate Nominee Executive Course on Trade Policy for Development TPD 1 July 2012 CE12109 First Name Middle Name Date of Birth month/day/year Male Birth County Female Family Name Birth City Citizenship Single Married CURRENT JOB INFORMATION Job T itle E-Mail Address Section/Division Agency Street Address Agency Name Agency City and Postal Code...Department Country Work Phone Number Home Phone Number Work Fax Number Alternative Fax Number Summarize your duties as they relate to the subject of the course. Please note that the application will not be processed without adequate description of current duties. IMPORTANT Please read the course description and qualifications to ensure that you are qualified for the course to which you are applying. Please confine your description to this space. PRIOR WORK EXPERIENCE Previous Job T itles Name of...Agency Dates Employed From To LANGUAGE S KILLS Which of the following languages do you read write and speak very well English Arabic EDUCATION Degrees/Diplomas Received Major Subjects Dates Attended Institution/University Country of Institution Language of Instruction IM F Institute Staff Reference Only Date Nominee s Signature Sponsor s Nomination and Certification Form Sponsor s First Name Sponsor s M iddle Name Sponsor s Family Name Sponsor s Nationality M r. M s. Sponsor s Job T itle Agency...T elex Number Agency Phone Number Agency E-Mail Address Agency Fax Number I the undersigned acting on behalf of the above named agency where the nominee is employed hereby sponsor the following nominee and certify the information below. Name of Nominee and Course Number CE12109 The information supplied by the nominee on preceding page is correct. The nominee if accepted as a participant in the course will receive a leave of absence with regular pay for the duration of the course and on return...will resume current duties or assume a new position* In case of withdrawal of a confirmed participant after the IMF has prepaid the airline ticket the sponsoring agency will be responsible for any travel costs incurred by the IMF and the sponsoring agency will be responsible for the costs of the participant s repatriation if any personal difficulties or circumstances arising during his/her participation in the course should render repatriation necessary. The IMF will be reimbursed promptly by...the sponsoring agency for all medical expenses that the IMF incurs as a result of any of medical conditions as well as for any medical expenses incurred by participants and family which are not covered by the IMF s medical insurance policy including pregnancy-related expenses. Agency Seal Date Certifying Sponsor s Signature Completed form should be sent to IMF CEF Institute Course Administrator E-mail CE12109 imf*org 965 2224 5055 Fax Tel W 965 2224 5114 Cell W 965 6701 0185. Please note that...the application will not be processed without adequate description of current duties. IMPORTANT Please read the course description and qualifications to ensure that you are qualified for the course to which you are applying.