Distance Education Course Application Form

Please Select Your Course(*)
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SECTION A: PERSONAL DATA

Surname(*)
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Middle Name (optional)
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First Name(*)
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Contact information
P.O. Box(*)
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Code(*)
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City/Town(*)
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Office phone No.
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Cell Phone No.(*)
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Email(*)
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Biodata
Gender(*)
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Nationality(*)
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Marital Status:
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Work details
Employer(*)
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Employer Address
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Work Email:
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Profession(*)
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Cadre(*)
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SECTION D: SUBMISSION OF MANUAL APPLICATION FORMS

If you have chosen to fill in and submit the MS Word application form and NOT this online form, kindly submit it to: The Administrator - DE Courses Directorate of Capacity Building, Amref Health Africa Tel: 254 (0) 20 6993000/3122 or Email: de@amref.org
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