SUMMER SCHOOL ON COUNTERFACTUAL IMPACT EVALUATION

Pracatinat – Torino – Italy August 31 - September 7, 2013

APPLICATION FORM

The application procedure

Applications must be received by May 20, 2013 and admissions will be decided by June 1st. Admitted participants should pay the fee by June 30 by wire transfer, in order to confirm their participation. All fees include 21% VAT, full room and board at Pracatinat, and transportation to and from Pracatinat from Torino's airport and railways stations, plus one night in Torino in a 3-star hotel.

Team participation

We favor the participation of team of 2 or 3 persons from the same organization, if they provide us with an idea for a policy they would like to evaluate Please select from the following:

Please select from the following: *

I'm the only applicant from my organization

I'm a member of a TWO-person team

I'm a member of a THREE-person team

The organization that employes me: *

PUBLIC

PRIVATE

MIXED (PLEASE EXPLAIN)

Organization name:

The other team components are:

The project we would work on refers to: (max 10 lines description)

Personal Data

First Name *

Last Name *

Gender *

male

female

Date of birth

Nationality *

Country of residence and work *

Contact Data

Address

ZIP

City

Phone

Mobile *

E-mail (IMPORTANT!) *

Educational and professional qualifications

Phd in (field)

From (institution)

Master in (field)

From (institution)

First Degree in (field)

From (institution)

Other relevant courses (max 2)

Other professional qualifications

Employment

Current position/professional activity *

since *

Name of employer/field of activity *

Work responsabilities that make taking this course relevant *

Other work experiences related to evaluation

Publications and research report

List a maximum of 2 publications (if any) or unpublished research report

Applicant's motivation

VERY IMPORTANT

Personal statement in support of your application to this course (max 250 words)

Curriculum vitae

Attach a CV, preferably in the EU format EUROPASS

Reduced fee request section

Progetto Valutazione, a non-profit organization devoted to promoting the use of rigorous evaluation methods, is willing to offer a discount in order to favor the participation of a more diversified set of evaluators. The reduced fee will be €1000. Progetto Valutazione is able to afford only a maximum of 10 reduced fees. In case there are more than 10 applications for the reduced fee, priority will be on age and the motivation provided. For applying for the reduced fee, please fill in the following.

I hereby declare that:

I am a freelance evaluator and I am self-financing the participation to the School

The organisation I am working for is not able to pay the full fee due to budget cuts

Please explain:

Additional reasons why I am asking for the discount:

* = Input is required