Field Seminars on UNDERSTANDING VOLCANOES 2013

FIELD SEMINARS ON UNDERSTANDING VOLCANOES 2013 Application Form I. PERSONAL DETAILS Salutation Choose an item. First Name (as in passport) Last Name / Surname (as in passport) Gender Choose an item. Date of Birth Choose an item. / Choose an item. / Choose an item. NRIC No. Passport No. Passport Issuing Country Passport Date of Issue Choose an item. / Choose an item. / Choose an item. Passport Date of Expiry Choose an item. / Choose an item. / Choose an item. Nationality Home Address

Email Address Contact Number School Name Designation Name of Principal Principal’s Email Address Medical Information (e.g. current medical conditions, current medication, allergies etc) Dietary Restrictions

Name of Emergency Contact Relationship Emergency Contact Number

II. SKILLS AND EXPERIENCE Number of years of teaching Choose an item. experience (in physical geography): Subjects that you currently Choose an item. teach Have you ever been involved Choose an item. in working on a geography field package? If yes, please give some examples of your recent contribution(s). Please briefly describe examples of the type of overseas school trips (related to geography) that you have previously led or participated in during the last five years. State (Country) Field sites visited that is related to Singapore’s Your involvement geography curriculum

III. LEARNING OUTCOME How would you like to share your learning with fellow colleagues upon completion of this field seminar?

IV. LETTER OF INTEREST Why should you be selected to be a part of this field seminar programme. What are some professional benefits (e.g. useful content knowledge, skills and fieldwork techniques) that you hope to acquire from this programme? (maximum 200 words) V. FIELD SEMINAR SELECTION Please indicate which is your preferred programme. (You may select only one option.)

5 Days / 4 Nights Batur Volcano, Bali (3 – 7 June 2013) --- $850 per person (estimated cost)

7 Days / 6 Nights Toba Caldera, Medan (9 – 15 June 2013)

(preferably for those who have previously gone on the field seminar to Merapi) --- $1000 per person (estimated cost)

Please indicate if you intend to extend your trip.

I WILL be extending my trip beyond the end of the official field trip. I understand that I am fully responsible for this personal travel.

I WILL NOT be extending my trip.

VI. OTHERS Other comments and suggestions.

I certify that to the best of my knowledge, the information supplied by me in this application is complete and correct.

Signature:

Date: Please email your completed application form to [email protected] by 18 January 2013 to be considered for your selected field seminar.