Apply to UM1 Yangon April Workshop | Myanmar Research and Research Ethics

UM1 YANGON APRIL WORKSHOP ONLINE APPLICATION FORM - APRIL 24, 25

Closing date for applications is March 31st 2018

PART I: PERSONAL INFORMATION

Name (as it appears in your passport)
Family/Surname *
First *
Middle *
Title *
Home Address *
Telephone Numbers
Home (country code + city code + number)
Mobile *(country code + city code + number)
Email *
Gender *
MaleFemale
Date of Birth *month/day/year
Place of Birth *City/Country
Citizenship *

PART II: PROFESSIONAL INFORMATION

Job Title *
Position *
Institution Name *
Institution Address *
Telephone (country code + city code + number)
Email

PART III: EDUCATIONAL BACKGROUND

Instructions Please list in chronological order all educational experiences leading to an academic degree.
1. College/University
City/Country
Dates Attended
Discipline
Degree
Date Degree Earned
2. College/University
City/Country
Dates Attended
Discipline
Degree
Date Degree Earned
3. College/University
City/Country
Dates Attended
Discipline
Degree
Date Degree Earned
4. College/University
City/Country
Dates Attended
Discipline
Degree
Date Degree Earned

PART IV: DESCRIPTION OF PRESENT WORK AND RESEARCH EXPERIENCES

Present POSITION/ DUTIES/ FUNCTIONS:
Describe your own EXPERIENCE IN HEALTH RESEARCH.

PART V: EXPERIENCE ETHICS AND RESEARCH ETHICS

Describe your own experience IN THE ETHICAL REVIEW OF RESEARCH (e.g., participation in a research ethics committee at your institution).
Describe your experience in the LEARNING OF ETHICS, for example, courses taken, workshops attended, etc. If none, state NONE.
Describe your own experience in the TEACHING OF ETHICS. If none, state NONE.

Part VI: FUTURE ACTIVITIES IN RESEARCH ETHICS

Please describe how the Certificate Program will help you enhance research ethics in your institution/ country. Please be specific regarding what kind of activities you will do (teaching activities, developing ethics committees, research projects, etc).

PART VII: OTHER APPLICATION MATERIALS REQUIRED

Instructions WITH YOUR APPLICATION – PLEASE ATTACH THE FOLLOWING:

1. A Curriculum Vitae (not more than five pages)
2. A Personal Statement
Upload CV *
Upload Personal Statement *
DECLARATION I declare that this information is completely accurate and without falsifications.
Signature *Type your name
Date *
Textarea

Verification

Please enter any two digits *Example: 12
This box is for spam protection - <strong>please leave it blank</strong>: