Call for Applications | Online course on “The Struggle for Health and Access to Medicines and Medical Products” for the SEAP (South East Asia and the Pacific) region July 14, 2022October 25, 2022 by gargeya Please enable JavaScript in your browser to complete this form.Personal InformationFirst Name *Last Name *Gender *MaleFemaleOtherDate of birth *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Nationality *Country of residence *City *Contact InformationPreferred Email ID *Alternate Email IDMobile *Professional InformationTitle, Affiliation or Profession *Institution *Institution Website / URLCity, Country *Education *Please describe your educational backgroundOccupation *Please describe your current ocupationPrevious and Current Health Activism *Please describe your involvement with health activismWhy is the course on Access to Medicines and Medical Products important for you and your activism? *Why do you want to participate in this course and what do you hope to be able to do afterwards?Area of interestsPlease list areas of particular interest relating to health and access to medical productsPrevious Course AttendedHave you attended any courses organised by PHM and TWN on 'The Struggle for Health and Access to Affordable Medicines'. Which one did you attend? *Not attended any previous courseSavar, Bangladesh-2018CapeTown, South Africa-2019Middle East and North Africa, Online Course-2020The Struggle for Health and Access to Covid-19 Medical Products- October 2021The Struggle for Health and Access to Covid-19 Medical Products- December 2021The Struggle for Health and Access to Covid-19 Medical Products- September 2022References:Please provide contact details (name, occupation, email, contact number (preferably mobile) of at least one reference who can speak about your health background/activism. Reference Language SkillsEnglish *ExcellentGoodFairPoorAny other language (please type in box) *Skills (Language 3) *ExcellentGoodFairPoorOnline Course NecessitiesDo you have access to a reliable computer/laptop *YesNoDo you have access to a reliable internet connection *YesNoDo you agree to commit at least 8-12 hours every week towards the course and course work *YesNoPhoneRegister
