Institution Please Select Institute Course Code & Name Please Select Course Course Dates Please Select Start Date Semester I Semester II Self-Paced Year Please Select Start Year 2010 2011 (Fill in 1 registration form per course)
NAME IN FULL SURNAME, GIVEN AND MIDDLE NAME SEX Female Male KNOWLEDGE OF ENGLISH Poor Average Good Excellent KNOWLEDGE OF IT Poor Average Good Excellent CURRENT OCCUPATION NAME OF ORGANIZATION EMAIL ADDRESS HOME/MOBILE TELEPHONE BUSINESS TELEPHONE POSTAL ADDRESS STREET/POST OFFICE BOX CITY COUNTRY
Educational background Previous Work experience Positions, tasks, locations Describe your areas of specialization, interest and capabilities that would in your opinion contribute to classroom discussions Expectations What do you hope to get out of the course? Which modules are most relevant to your work? Which order would you like to do the modules? Current problems that you face in your organization relating to your work? Time allocation (Time that you will allocate to the course 1) at work, 2) personal time)
(I declare that the information supplied on this form, is to the best of my knowledge, complete and correct)