Sustainable Microfinance and Development Programme 2017 – Pietermaritzburg, South Africa

Monday March 27, to Friday April 7, 2017

Application deadline:

Tuesday March 7, 2017

No applications received after this date will be considered

Please complete this application in its entirety and send via e-mail to *

1 Biodata

·  Prefix (Ms. Mrs., etc.):

·  First Name:

·  Middle Name:

·  Last Name:

·  Job Title:

·  Company/Organization:

·  Address Line 1:

·  Address Line 2:

·  City:

·  Country:

·  Home/Cell Phone:

·  Work Phone:

·  Country Passport Issued From:

·  Passport Number:

·  Emergency Contact Name:

·  Emergency Contact Phone:


Please answer all questions from A to F in the space provided below:

A.  Please describe your current position and previous experience stating your educational and professional background. Also include your past and current employment in the Microenterprise/microfinance development field. Your statement will be shared with Facilitators and Students. Maximum 250 words

B.  What is the size of the institution you work for by:

a.  Number of projects

b.  Total number of beneficiaries/members/clients across all projects

c.  Number of savers

d.  Number of borrowers

C.  What is the geographic area you work in

a.  Country

b.  Region

D.  What are your responsibilities in terms of

a.  Programme design

b.  Programme implementation

c.  Programme policy

E.  Specifically, how will you apply what you expect to learn from the SMDP course or courses for which you are applying?

F.  Name of Your Sponsor:

a.  Other Sponsor Contact Info: (Address, City Country, Postal Code, Telephone, Email, Website)

2 Course Selection

Please select the course or courses that you wish to attend by placing a large ‘X’ in the box or boxes on the left hand side to indicate your choice(s). You may apply for one or both courses at the same time.

Before making course selections please refer to the course descriptions by clicking on the URL below


https://carsey.unh.edu/smdp/southafrica/courses

Select with an ‘X’ in the box below / WEEK ONE March 27 – March 31
Savings Groups: Programme Design and Implementation Management
Select with an ‘X’ in the box below / WEEK TWO April 3 – April 7
Savings Groups: Management Information Systems

3 Course Tuition and Room and Board

Tuition includes all books, reading materials, USB, and field trips. Room and Board includes breakfast, lunch and dinner for six days for a one-week enrollment and 13 days for a two-week enrollment, coffee/tea breaks twice per day Monday through Friday and field visit transportation costs.

Select One-week enrollment OR Two week enrollment ONLY and put an ‘X’ to indicate if you will be resident at the hotel or will commute to classes from private accommodation in Pietermaritzburg

Courses / Residential / Enter X Below /

Commuter

/ Enter X Below
One Week Enrollment
March 27 – 31
OR
April 3 - 7 / $2,100 / $1, 300
Two Weeks Enrollment
March 27 – April 7 / $4,000 / $2,400


4 Attestation

By submitting this application, I certify that I will be responsible for all travel expenses from my home city and country to Pietermaritzburg, South Africa and all costs related to tuition, room and board. I agree to pay the full amount as listed in 3. Course tuition and Room and Board by Monday the 13th March. If I do not transfer the fees by the 13h March, I understand that my place may be given to another applicant and that the SMDP will not be responsible for any costs I may have incurred.


Please type your initials below.

Yes ______No______

Payment Information

A deposit of $500.00 is due within 10 days of registration. The balance of workshop fees are due before your arrival in Pietermaritzburg. Payments may be made by credit card or wire transfer. Wire transfer is preferred.

The following is our reimbursement policy in the event of cancellation:

Two weeks or more prior to the workshop: Full reimbursement, less transfer fees

One week to two weeks prior to the workshop: 50% reimbursement, less transfer fees

Less than one week from the workshop: No reimbursement

Wire transfer

Please contact VSL Associates on or telephone +49 176 72483304 or +49 212 818305 for Wire Transfer InstructionsTransaction must be completed in U.S. Dollars

Be sure to include your name on the draft and send us an email letting us know that it has been processed. Please add a $35 fee to cover the cost of the transfer and other Bank charges. Note, there is no standard rate for such costs and therefore it may vary from the recommended $35. In such a case, if your payments are either short or greater than the amount you owe, we will settle it while you are at the SMDP. The payment amount will be based on the notification we receive from our bank as to what the actual deposit is, therefore make sure you correspond with us at regarding this.

Credit Card:

If you wish to pay by credit card please contact the SMDP office at or call +1 603-862-1871 and we can take your card information over the phone.

Once your deposit or full payment has been received we will send you an e-mail confirmation and will e-mail you a Letter of Acceptance, which you may need when applying for a South African visa.


Note: No cash payments for tuition and housing costs will be accepted at the program.

5 Visas for South Africa

Detailed information on application for a South African visa is available at http://www.dha.gov.za/index.php/applying-for-sa-visa

If a letter of support is required please write to with the subject ‘Support letter for visa application’

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