Global Human Rights Leadership Training Institute (GHRLTI)

(Human Rights & Justice Group Int’l)

APPLICATION FORM

ONLINE DISTANCE EDUCATION COURSE

Please Type or Print Legibly in Ink

COURSE TITLE AND PROPOSED DATE
PERSONAL DETAILS
Last Name(s): / First Name(s):
Gender: [ ] Male [ ] Female
Postal Address:
Physical Address (if different from above):
Telephone (plus country and local code): / Skype ID (If any):
Mobile/Cell Phone: / Personal E-mail Address:
Date of Birth: / Country of Residence:
EMPLOYMENT DETAILS
Employer’s Name:
Address:
Telephone (plus country and local code): / E-mail Address:
Brief outline your responsibilities:
COURSE HISTORY
Have you participated in any of our training courses before? If yes, indicate the course title:
ENGLISH LANGUAGE ABILITY
Please indicate below your knowledge (excellent, good, fair, or poor) of the English Language
Reading / Writing / Speaking
COURSE RELATED COSTS
(Please tick an X the appropriate box in the space below if you are able to support yourself in full or part in terms of the costs of the course.).
Yes, I can pay for the cost [ ] / No, I require partial scholarship [ ]
PROFESSIONAL GOALS
Please write a statement of not more than 200 words, explaining why you wish to participate in this training and how the training will help you achieve your goals.
MOTIVATION
What do you expect to gain from your participation in the course?
PARTICIPATION
Directory of Participants
The directory of participants is an invaluable tool for making contacts and networking during and after the program. It includes the contact information and a short biographical note for each participant, facilitator and resource person and for their organisation. The list is distributed to all participants at the end of the program.
Would you like to be included in this directory? [ ] Yes [ ] No
PERSONAL INFORMATION
Please print clearly the email address you will be using for the course:
Do you have access to Internet? [ ] Yes [ ] No
Please return this form duly completed together with the following documents:
  • Passport photo (This will be posted on the course platform) [ ]
  • Curriculum Vitae [ ]

The Candidate
By signature below, I certify that to the best of my knowledge, the information provided in all parts of my application is accurate and complete.
Name Initial: / Date:

Please email the completed application to: R

GHRLTI

Human Rights and Justice Group Int’l

Nigeria: 53, Western Avenue, P.O. Box 3326, Surulere, 101014, Lagos, Nigeria

Tel: +234-8034923400, 08097627319

U.S.A.: 1 Mifflin Pl. Suite 400, Cambridge, MA 02138, USA

E-mail: |Website: