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People Living in Unified Society Training Team

PEOPLE LIVING IN UNIFIED SOCIETY (PLUS)

LOGICAL FRAMEWORK APPROACH (LFA)

TRAINING APPLICATION FORM

Failure to complete in full may delay your registration PLUS use only
and affect your eligibility.
Date Received: .................................

Personal Summary
Name in English: Permanent Home Address:
Name in Khmer:
Gender: □Male □Female
Photo
Date of Birth (DD/MM/YY): / /
4x6
Mobile Phone:
Email:
Skype:

Industry
Industry Name: Industry line:
□ Private □ NGO □ UN
Acronym:
□ Other (specify)....................................
Address: Office Telephone:
Office Email:
Your position:

Line Manager’s Name: Mobile Phone:

Position: Email:

How do you know about this training course?


□ PLUS Website/ Homepage □ Your Friends □ MEDICAM Email
□ PLUS Email □ CCC Email □ The Cambodia Daily
□ Others (specify)..........................................................

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People Living in Unified Society Training Team

Date and Time

Please check appropriate box:

□ Group I (full-time class): June 20-24, 2011 (7:30 am – 11:30 am and 1:30 pm – 5:30 pm)
□ Group II (weekend class): June 25-26, 2011 and July 2-3, 2011 and July 9, 2011 (7:30 am –
11:30 am and 1:30 pm – 5:30 pm)
□ Group III (part-time class): June 20-23, 2011 and June 27 - 30, 2011 and July 4-7, 2011 and July
11-14, 2011 (6:00 pm – 8:30 pm)

In the year ahead, what sort of training courses do you think you really need?

Date Applicant’s Name Signature

........./............/.......... ............................... ...............................

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