Title
Mr Ms Mrs Dr Prof.

First name(s)

Family name

Nationality

Dietary requirements

Disabilities

Have you participated in a PAI study programme before?
Yes
No

If yes, when and which programme(s)?

How did you find out about this programme?

Current Position:

Title of post

Full name and address of your employer

Postcode/Zipcode

Telephone Number (including international dialling code)

Fax Number (including international dialling code)

Email Address

Brief description of your main role and responsibilities

Education and professional training:

Please provide brief details of your educational and professional qualifications and training

School/college/university

Relevant professional qualifications or membership of professional bodies

Particular Interests:

Please indicate which aspects of the programme are of most interest to you?

Sponsoring organisation:

Who will pay for your fees?

Who will pay your other costs such as travel and living costs?

How would you rate your English language capability?

Do you need a visa to enter UK?

If you are unsure whether you need a visa please check the UK Border Agency website at www.ukvisas.gov.uk

Value Added Tax (VAT):

I certify that I am employed by the Government in furtherance of its sovereign activities (please refer to note on VAT under "Fees and other costs")
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