9. Name and address of a person to notify in case of an emergency 10. Relationship Telephone number: 11. English language proficiency 12. Food preferences (Please tick where appropriate) ( ) Vegetarian (E Excellent, G Good, F Fair) ( ) Non-vegetarian – – – ( ) Other, specify: Reading Writing Speaking E G F E G F E G F ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) Please note that the course is delivered in English only. Participants should be fluent in reading and speaking English. 2. EDUCATION, RELATED EXPERIENCE, AND CURRENT EMPLOYMENT 13. Education with the last institution attended. Please use an additional sheet or refer to your resume, if necessary.) Institution Year(s) attended Field of study Degree 14. Current employment (Please attach your resume for more information about your employment history.) 15. Memberships of professional societies (Please use an additional sheet or indicate in your resume, if necessary.) 16. Give a brief description of your present involvement in professional activities related to the Minimum Initial Service Package (MISP) for Sexual and Reproductive Health in Emergency Settings and other emergency management work. (Please use an additional sheet, if necessary.)
9. Name and address of a person to notify in case of an emergency 10. Relationship Telephone number: 11. English language proficiency 12. Food preferences (Please tick where appropriate) ( ) Vegetarian (E – Excellent, G – Good, F – Fair) ( ) Non-vegetarian ( ) Other, specify: Reading Writing Speaking E G F E G F E G F ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) Please note that the course is delivered in English only. Participants should be fluent in reading and speaking English. 2. EDUCATION, RELATED EXPERIENCE, AND CURRENT EMPLOYMENT 13. Education with the last institution attended. Please use an additional sheet or refer to your resume, if necessary.) Institution Year(s) attended Field of study Degree 14. Current employment (Please attach your resume for more information about your employment history.) 15. Memberships of professional societies (Please use an additional sheet or indicate in your resume, if necessary.) 16. Give a brief description of your present involvement in professional activities related to the Minimum Initial Service Package (MISP) for Sexual and Reproductive Health in Emergency Settings and other emergency management work. (Please use an additional sheet, if necessary.)
2016-sXOa6E-ADPC-ApplicationForm.docx