Development Case Team Cover Sheet

Case: __________________________________________
Indicate A, B, C or D.

Abstract word count: _______________________________________________________________________

Maximum: 400

Proposal word count: ______________________________________________________________________

Maximum: 2,000

Date of Submission: _______________________________________________________________________

MM/DD/YYYY

Team Information
Team Name: _____________________________________________________________________________
Team Members:
Enter details of team members below. Teams must have a minimum of two and a maximum of five members. Members must be
between 18 and 35 years old as on October 3, 2013. Please enter date of birth (DOB) in MM/DD/YYYY format.

Select from list

1. Prefix:
First Name: _________ Last Name: _________ City and Country: ____________________ DOB: _______
Status: Select from list
Occupation (or field of study/major): _____________ Type of organization: Select from

list

Select from list

2. Prefix:
First Name: _________ Last Name: _________ City and Country: ____________________ DOB: _______
Status: Select from list
Occupation (or field of study/major): _____________ Type of organization: Select from

list

list_________ Last Name: _________ City and Country: ____________________ DOB: _______
3. Prefix: Select
Firstfrom
Name:
Status: Select from list
Occupation (or field of study/major): _____________ Type of organization: Select from

list

list_________ Last Name: _________ City and Country: ____________________ DOB: _______
4. Prefix: Select
Firstfrom
Name:
Status:
Occupation (or field of study/major): _____________ Type of organization: Select from

list

Select from list

5. Prefix: Select
Firstfrom
Name:
list_________ Last Name: _________ City and Country: ____________________ DOB: _______
Status: Select from list
Occupation (or field of study/major): _____________ Type of organization:

Select from list

Team Leader: ____________________________________________________________________________

Please indicate one person on the Team.

Affiliation: _______________________________________________________________________________
If the Team has an institutional affiliation (such as a university or a non-governmental organization), list that here.

Contact Information
E-mail address: ___________________________________________________________________________
Phone Number: ___________________________________________________________________________
+country code area code number