C o n f e r e n c e S c h o l a r s h i p F u n d

A p p l i c a t i o n F o r m

Proponents are asked to submit this form electronically as a file attached to an email or as a file on a 3.5 inch pc-formatted diskette mailed to infoDev. The file should be in Microsoft Word or RTF format. If you do not have access to these formats, make sure your application contains all the information requested below.

Proponent should read the guidelines before completing thean application form.

1. Conference title:	International Workshop for The Community Development with E-Learning and E-Healthcare in Amazon, Brazil
2. Dates of conference:	March 17 to 21, 2003
3. Location:	Manaus, Amazon, Brazil
4. Short description of the event:	This international workshop is to brainstorm on and to form a committee for the deployment of broadband Internet in Amazon, Brazil, with CampusNet via satellite and with the Community Development Networks (CDNs) via wireless units. Their deployment will utilize a community development approach with the involvements of all schools, libraries, hospitals, local governments, non- and profit-organizations to have global E-Rate. Joint contents development, teacher and general-public training for digital literacy will also be discussed. This project will promote the use of information and communication technologies (ICT) for economic and social development with special emphasis on the poverty and isolation reductions in Amazon region. The resultant comprehensive documents out of this workshop will be submitted to the Japanese governmentπs ≥non-tied cultural aid.≤ Global University System will emulate this project in other developing countries around the world in the future. This is a joint project of the University of Amazonia (UA) in Brazil, the Global University System (GUS) at the University of Tampere, Finland, and the GLObal Systems Analysis and Simulation Association in the U.S.A. (GLOSAS/USA)

5. Proponent / Conference Organizers	≠ ≠ Please attach a brief statement of the goals, activities, and capability of the organization ≠ See the following section in the grant application submitted to Tinker Foundation attached herewith; Section VI: GOAL AND Objectives of Workshop Section VII: Activities during Workshop Section VIII: Activities after Workshop Section XVI: Proponent Capability Statement
Name:	Professor Doctor Alexandre Almir Ferreira Rivas Principal-Investigator
Title:	General Director of the Center of Sciences of the Environment
Organization Name:	Universidade Federal do Amazonas / FundacaoUNI-SOL
Address:	Campus Universitario 3000 Manaus, AM Brazil 69000
Phone Number:	+ 55-92-647-4063
Fax Number:	+ 55-92-647-4066
E-Mail Address:	alex_mau@argo.com.br
Organization web site:	http://www.fua.br
Conference web site:	Under construction.

Type of Organization Please indicate what type of organization the applicant is:
Academic/Research Institution	[ X ]
Non- Governmental Organization	[ ]
Private Enterprise	[ ]
Government Agency	[ ]
Regional or Bilateral Organization	[ ]
United Nations Agency	[ ]
Other (please explain)	[ ]

Previous infoDev grant

[ ]YES [ X ]NO University of Amazonas [ X ]YES [ ]NO University of Tampere

6. Participating organizations

Please give contact information, including email addresses and website when available.

See the following section in the grant application submitted to Tinker Foundation attached herewith;

APPENDIX IX: List of Participants

7. Description of the conference ≠ ≠ Please Attach the Conference Program or a list of planned conference activities ≠ See the grant application submitted to Tinker Foundation attached herewith.
Background:	See the following section in the grant application submitted to Tinker Foundation attached herewith; Section IV: ACTIVITY BACKGROUND
Objectives of the conference:	See the following section in the grant application submitted to Tinker Foundation attached herewith; Section VI: GOAL AND Objectives of Workshop
Main conference activities:	See the following section in the grant application submitted to Tinker Foundation attached herewith; Section VII: Activities during Workshop Section VIII: Activities after Workshop
Size of the conference:	50 to 75
Type of participants in the conference in general:	Professors and staffs of university and its hospital, teachers of secondary and elementary schools, librarians, staffs of local governmental agencies, information and telecom specialists, etc.
Type of fellows to be funded by infoDev:	Professors and staffs of university and its hospital, teachers of secondary and elementary schools, etc.
Conference Category Please choose from the following ONLY ONE of the most relevant category for the proposed conference: (if necessary you may choose a second, but please mark as primary and secondary). infoDev will not consider anything beyond the primary and secondary categories:
Telecommunications Infrastructure Development		[ ]
Internet Infrastructure Development		[ X ] Primary
Education		[ X ] Secondary
Health		[ ]
E-Commerce		[ ]
Agriculture and Rural Development		[ ]
Environment		[ ]
Government		[ ]
Other (please explain)		[ ]

8. Please describe why the conference is important to the candidate fellows. Include how they would apply the knowledge gained and how they would disseminate it to a wider community.

The candidate fellows (who are mainly faculty members of the CampusNet affiliated universities) and American colleagues (whose travels will be financed by the US National Science Foundation) will discuss on the followings;

(a) To plan and configure the deployment of the CampusNet and the Community Development Networks (CDNs) with the Japanese governmentπs ODA fund.  (Incidentally, the Brazilian government has already pledged US$2.8 million for the CampusNet.)

In order to obtain this ODA fund, we will produce a comprehensive document of system design, feasibility study, market survey, action plan, design of organizational structures for technical support and administration, etc., during and after our proposed workshop.

(b) To plan and configure joint research and development programs and projects among the CampusNet affiliated universities and the US counterparts through the CampusNet and CDN.

(c) To plan and configure e-learning and e-healthcare programs and projects (i) among CampusNet affiliated universities and (ii) with the US counterparts through the CampusNet and CDN.

See APPENDIX VIII of the grant application submitted to Tinker Foundation attached herewith for the above Items (b) and (c).

After the workshop is over, the candidate fellows will become the key persons for the deployments of the CampusNet and the CDN in the cities of the main campuses of the CampusNet affiliated universities.

9. Please describe how you select the participants from developing countries to be supported by your program under the iCSF grant.

The CampusNet affiliated universities are located in remote/rural areas of the Amazon region. The candidate fellows from those universities are capable persons for the aforementioned discussions.

Those universities will become the members of our GUS/UNESCO/UNITWIN Networking Chair Program.

See the following sections in the grant application submitted to Tinker Foundation attached herewith;
Section VII: Activities during Workshop

Section XI: Sustainability plan/B: As for Overall Project including CampusNet and CDNs/6. UNESCO

Section XVI: Proponent Capability Statement/B. Global University System (GUS)

10. Please describe how you plan to disseminate the results of the conference.

See the following sections in the grant application submitted to Tinker Foundation attached herewith;
Section XIV: Anticipated results of the project and Deliverables

Section XV: dissemination of the results

11. Financial Data (Please indicate all amounts in US Dollars.)
Total iCSF funding requested:	To be filled up later.
Total cost of the event:	To be filled up later.
Sources of Co-financing:	(1) Tinker Foundation (for main workshop arrangements) (2) US National Science Foundation (for travel grant for Americans) (3) The William and Flora Hewlett Foundation (tentative) (4) EDS/Latin America (tentative) (5) Inter-American Development Bank (tentative) (6) International Telecommunications Union (ITU) (tentative)

12. Conference Budget	iCSF Funding	Own financing/Co-financing
General Conference Arrangement		To be filled up later.
Travel	To be filled up later.	To be filled up later.
Accomodation	To be filled up later.	To be filled up later.
Per Diem	To be filled up later.	To be filled up later.
Conference participation fees		To be filled up later.
Other		To be filled up later.
Total budget for the event:		To be filled up later.

13. Number of sponsored participants (iCSF Fellows):

To be filled up later.

14. Financially responsible party for iCSF grant ≠ The designated person to sign a grant agreement on behalf of the organization ≠
Name:	Professor Doctor Alexandre Almir Ferreira Rivas Principal-Investigator
Title:	General Director of the Center of Sciences of the Environment
Organization Name:	Universidade Federal do Amazonas / FundacaoUNI-SOL
Address:	Campus Universitario 3000 Manaus, AM Brazil 69000
Phone:	+ 55-92-647-4063
Fax:	+ 55-92-647-4066
Email address:	alex_mau@argo.com.br
Other Contact persons:	Takeshi Utsumi, Ph.D., P.E. Co-Principal Investigator President Emeritus and V.P. for Technology and Coordination of Global University System (GUS) Chairman, GLObal Systems Analysis and Simulation Association in the U.S.A. (GLOSAS/USA) 43-23 Colden Street Flushing, NY 11355-3998 U.S.A. Tel: +1-718-939-0928 Fax: +1-718-939-0656 utsumi@columbia.edu http://www.friends-partners.org/GLOSAS/

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Annex to iCSF Application Form:

Proposed iSCF Fellows

Please list, in order of priority, the individuals from developing countries that you intend to support with the iCSF grant, minimum 5. Please fill out all the indicated fields!

.

An iCSF grant can only be awarded after a list of fellows, complete with the information below, has been submitted and accepted. We strongly recommend that you list an additional 25% alternates, in case selected participants is unable to attend the conference.

If you have not yet selected the candidates, in the interim please submit instead a declaration of:

ß Which countries the intended participants originate from;

ß Current role in the home country of intended participants;

ß Reason for intended participants to attend conference;

ß When you expect to submit the complete list of proposed fellows.

1

Name:			Gender:
Email Address:
Employer:
Job Title:
Role of participant in home country:
Reason for attending conference:
Funding Requested	Unit Cost	Total
Travel (less than business class)
Accomodation or Per Diem
TOTAL COSTS

2

Name:			Gender:
Email Address:
Employer:
Job Title:
Role of participant in home country:
Reason for attending conference:
Funding Requested	Unit Cost	Total
Travel (less than business class)
Accomodation or Per Diem
TOTAL COSTS

3

Name:			Gender:
Email Address:
Employer:
Job Title:
Role of participant in home country:
Reason for attending conference:
Funding Requested	Unit Cost	Total
Travel (less than business class)
Accomodation or Per Diem
TOTAL COSTS

4

Name:			Gender:
Email Address:
Employer:
Job Title:
Role of participant in home country:
Reason for attending conference:
Funding Requested	Unit Cost	Total
Travel (less than business class)
Accomodation or Per Diem
TOTAL COSTS

5

Name:			Gender:
Email Address:
Employer:
Job Title:
Role of participant in home country:
Reason for attending conference:
Funding Requested	Unit Cost	Total
Travel (less than business class)
Accomodation or Per Diem
TOTAL COSTS