QUESTIONNAIRE
Last name:     First name:    
Sex:     Number of dependants    
(If any):
Date of birth:     Place of birth:    
Citizenship at birth:     Present citizenship:    
Country of origin:     Country of residence:    
Total years abroad:    
How would you like to be contacted:
a) Address (street, town, postal/zip Code, country)            
           
b) Telephone number            
c) Mobile Phone            
d) Fax            
e) E-mail            
Education level:     Field of study:    
Occupation/Profession: (Choose one or more from the list):
  Accounting   Information Science
  Aeronautic   Internist
  Agronomy   Law
  Animal Science   Management
  Anthropology   Mathematics
  Archaeology   Mechanical Engineering
  Astronomy   Medicine           
  Biology   Meteorology
  Biometrics   Mining
  Business Administration   Natural Science
  Civil Engineering   Ophthalmology
  Computer Science   Pedagogy
  Curriculum Development   Personnel Management
  Dermatology   Physical Science
  Econometrics   Plant Science
  Educational Administration   Political Science
  Electrical Engineering   Psychology
  Epidemiologist   Radiology
  Finance   Sociology
  Forestry   Statistics
  Gender Specialist   Surgeon
  Geology   System Analyst
  Industrial Chemistry   Theology
  Information Management   Trade
Others, please specify              
Years of work experience:        
Do you want to work in Africa? Yes   No  
If Yes, your interest in working in Ethiopia is: High   Low  
Other African countries you would like to work in (list in order of priorities):
       
       
       
In what way would you like to participate
Virtual (ex: tele-conferencing, internet based participation, etc.)  
One time mission    
Sequenced/Repeated Visits  
Investments    
Permanent return    
Do you belong to any Diaspora network(s)? Yes   No  
If yes, please specify              
How did you get hold of this questionnaire?
Web site (Please specify)            
Association/Network (Please specify)            
Friend, relative, neighbor, co-worker      
Email from IOM            
Other (Please specify)            
Disclaimer:
I declare that the information provided can be:
  + made available to other institutions participating in the MIDA program  
  + used by IOM only  
Note: Please attach your CV (Optional)
Thank you for your time!