Application form for Instructor-led Online Course on WASH Climate Resilience First Name This is required. Family Name This is required. Gender Male Female Other Rather not say This is required. Date of birth Position/Job Title This is required. Email address This is required. What country are you currently working in? Afghanistan Åland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil Brunei Bulgaria Burkina Faso Burundi Cape Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China Colombia Comoros Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Democratic Republic of the Congo East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Republic of the Congo Réunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Svalbard and Jan Mayen Sudan Suriname Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu United Kingdom United States Unknown Uganda Ukraine United Arab Emirates Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Western Sahara Yemen Yugoslavia Zambia Zimbabwe This is required. What is your level of English? Basic conversation and reading Working level Good standard of written and spoken This is required. Do you confirm that you will make the necessary time available (4 hours per week) to complete the course and all requirements (follow reading, discussion forums, quizzes and assignments) if you are selected? Yes No This is required. Please provide a few lines (less than 100 words) on your background This is required. Which organisation do you work for? UNICEF GWP Country or Regional Water Partnership National or State Government Cap-Net affiliated network This is required. Which section do you work in? WASH DRR Climate Emergency Other This is required. What is your current employment status? FT TA Consultant Intern Volunteer This is required. Are you a national or international staff member? National International This is required. How long have you been working for UNICEF? (years) This is required. Write a motivation statement (less than 100 words) This is required. Have you participated in the Strategic Framework workshops in 2019 in Dakar (May 2019) or Kathmandu (2019)? Yes No This is required. Have you enrolled in any UNICEF-supported WASH course in the last two years? If so, please state which course and the date This is required. Which Ministry or Office are you working in? This is required. Are you working for National or Sub-national Government? National Sub-national This is required. Please provide the name of the UNICEF staff who has recommended your participation This is required. Which GWP Country or Regional Water Partnership partner are you member of? This is required. Which Cap-Net affiliated network are you member of? This is required. Submit {{#message}}{{{message}}}{{/message}}{{^message}}Your submission failed. The server responded with {{status_text}} (code {{status_code}}). Please contact the developer of this form processor to improve this message. Learn More{{/message}}{{#message}}{{{message}}}{{/message}}{{^message}}It appears your submission was successful. Even though the server responded OK, it is possible the submission was not processed. Please contact the developer of this form processor to improve this message. Learn More{{/message}}Submitting… Back to Online Courses
