Application Form – UK Training

[db_form id=Reflective_Practice_2016]

for Training Course “Tools for Reflective Practice, January 10-18, 2016 in Wales, United Kingdom

Application deadline: 20.11.2015
You will be informed about the selection result on: 30.11.2014

Your details

The contact details you provide us below will be used for all correspondence!

[label]First name (as on your passport)[/label] [input name=sql_first_name required=true] [label]Surname (as on your passport)[/label] [input name=sql_surname required=true] [label]Date of birth (DD/MM/YYYY)[/label] [input name=sql_dob required=true] [label]Place & country of birth[/label] [input name=sql_pace_of_birth required=true] [label]Gender[/label] [select name=sql_gender required=true options=Male;Female] [label]Home address[/label] [input name=sql_home_address required=true] [label]Post code[/label] [input name=sql_home_postcode required=true] [label]City[/label] [input name=sql_city required=true] [label]Country[/label] [input name=sql_country required=true] [label]Phone
(preferably mobile with full international dial codes)[/label] [input name=sql_phone required=true] [label]Facebook profile[/label] [input name=sql_fb required=true]

 

Please describe about yourself and your motivation to participate in this event.

Tell us a bit about yourself and why do you want to get involved in this project.

[textarea name=sql_knowledge_experience required=true close=false]

Knowledge and experiences

What is your personal/professional experience in relation with this topic ? Or maybe ideas or past experience you can share about this topic

[textarea name=sql_knowledge required=true close=false]

Expectation

Please describe what do you expect to learn, understand and experience during this training course?

[textarea name=sql_expectation required=true close=false]

Language(s) spoken:

Please mention all languages in which you are able to work and indicate your level for each of it (B-basic, G-good, VG-very good, F-fluent, MT-mother tongue)

Please note that working language for this course will be English.

[textarea name=sql_language_abilities required=true close=false]

Do you have any special needs or requirements that the host organization should know about?

(E.g. mobility, medical needs, allergies, dietary restrictions, smoker/non-smoker)

[textarea name=sql_special_needs required=false close=false]

Anything else we forgot to ask but you would like to add?

[textarea name=sql_misc required=false close=false]

Disclaimer & Agreement

By agreeing to participate on the project I confirm that I will be responsible for my own behaviour and will do my upmost to ensure that I am participating and engaged fully in the whole programme. I agree that the information in this application is correct and sincere and that I will inform the course organisers of any change in my application/participation immediately.

[label]Please put your initial here to confirm[/label] [input name=sql_disclaimer required=true]

 

[submit value=Send_Application] [send_confirmation]

Thank you for your submitted application for Training Course “http://www.act-global.org/tools-for-reflective-practice/

You will be informed about the selection result on: 30.11.2014
Please note that you should not buy or book your tickets before the selection process and without our confirmation from the Act Global Team.

Please <a title=”Facebook” href=”https://www.facebook.com/ActGlobalCIC?ref=hl” target=”_blank”>follow us on Facebook</a> to get an update on our future events!

[/send_confirmation] [/db_form]