KODE: Kimmage Open & Distance Education

1. The course fee covers registration, introductory workshop with lunch, course materials, tutor and technical support for duration of course.

2. Course places will be booked on a first come-first served basis.

3. Important Notice Regarding Cancellation of Course places: Participants who cancel their place on a course less than one week before the course is due to begin will be obliged to pay the full course fee.

PERSONAL DETAILS

Name:

Tel:

Tel (Work):

Address:

Age:

E-Mail:

Country:

QUALIFICATIONS

Please give details of all relevant post-secondary qualifications:

WORK EXPERIENCE

Name of Current Organisation or Employer:

Which of the following best describes the Organisation you work for?

NGO/Civil Society
Local Government
Private Company
Missionary
Other

Job Title:

Current Position:

Full-time Staff
Part-time Staff
Short-term Volunteer
Long-term Volunteer
Missionary
Other

How many years' relevant experience?

Which countries have you worked in?

Briefly describe development wk. experience + current role:

KODE COURSES
Project Planning & Proposal Writing (8 weeks) 03.10.09, Kenya 03.10.09, Tanzania 03.10.09, Ireland Monitoring & Evaluation (4 weeks) 10.10.09, Kenya 10.10.09, Tanzania 10.10.09, Ireland
Which are you?
Dietary Needs (Introductory Workshop):
Any Special Needs:
Name of Current Organisation or Employer:
Where did you learn about KODE?
Support Agency Details (if applicable):	Type Name, Agency, Address, Telephone Number, Website in this box