Please complete this application form and email it to dih-ihl@uottawa.ca before April 16th 2018.

General Information

Title/prefix

First name

Last name

Are you a citizen or permanent resident of Canada Yes No

Street address

City

Province

Postal Code

Telephone

Email

Confirm email

Complementary Information Do you have any food allergies (please indicate):

Person to contact in case of emergency(please indicate name and telephone) :

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Participant Affiliation1. Category : Student

a. Academic institution:

i. University of Ottawa

ii. Other University (Please indicate the name of your institution and the faculty)

_________________________________________________

b. Years of studies completed (at the date of beginning of the course) :

c. Are you applying with accreditation purposes? YES

NO

2. Category : Professionala. Are you a Canadian Red Cross member?

b. Institution (Please indicate the name of your institution according to your situation)

c. Job title : __________________________________________________________

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Faculty of Civil Law

Faculty of Common Law

Faculty of Social Science

Other faculty (_________________)

yes No

Category Institution’s nameAcademicGovernmentMediaInternational OrganizationInternational BusinessNGO

MotivationPlease explain the reasons why you are interested in taking this course(Use a separate document if more space is required)

Language ProficiencyPlease indicate your proficiency (i.e. N/A, basic or fluent) in:

English*

French*

* You may be required to provide an official proof of language proficiency (ex.: TOEFL, TEF)PLEASE NOTE: Some sessions will be bilingual.

Language of Course InstructionPlease indicate the language in which you would like to take the course

English :

French :

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Note: - Please provide a copy of your C.V. - If you are applying for credits, please provide a copy of your transcript (unofficial)- Please note that attendance is mandatory for successful completion of the course. - Acceptance or refusal to attend the course will be sent to the email address provided by the applicant in

this application. - Important: Applications will not be processed without this form duly completed- The Tuition Fees for the 12th Edition IHL 2018 are:

- Please do not send your payment with the registration form, instructions for payment will be sent upon confirmation of registration.

Cancellation Policy: Once your participation is confirmed, a 100$ administrative fee will be charged for cancellations. In order to claim the rest of the fees, you must inform the organizers of your inability to participate in the course at least one week before the first day of the program.

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Students (Certificate only)The student rate for the certificate only is available for students who are registered full-time at a Canadian university and do not wish to take the course for credit. Proof of student status is required.

$750 CAD

Students (Certificate + Credits)- Students (regardless of the institution they are

attending) who wish to take the course for credit will be subject to the University of Ottawa’s tuition & fees policy.

- Credits will only be provided to undergraduate students under Pass/Fail mark. Evaluation will be based on a 8,000 word take-home exam on assigned subjects which is to be submitted no later than July 3rd, 2017

To be determined by University of Ottawa’s tuition & fees policy

Professionals (including international students) $1,250 CAD