PUBLIC HEALTH IN COMPLEX EMERGENCIES
TRAINING PROGRAM
www.phcetraining.org
APPLICATION FORM – 2015
Please check the course you wish to attend:
___to be announced:
___to be announced:
2nd – 14th Nov 2015:
American University of Beirut, Lebanon
Asian Disaster Preparedness Center, Thailand
Makerere University School of Public Health, Uganda
Name:
Nationality:
Permanent mailing address:
Date of Birth:
Male/ Female:
Current work address:
Mob.
e-mail:
Work telephone:
Fax:
Alternative e-mail:
Home/mobile telephone:
You may attach a resume or CV in place of questions 1-4:
1. Organization/ institution where you are employed:
2. Current job title & brief description of duties and responsibilities:
3. Other related emergency public health field experience:
4. Education:
5. English proficiency:
Comprehending spoken English
Reading Text
Poor
Fair
Good
Excellent
6. Please list your expectations from the Course:
7. Would you like to do a presentation? Informal lectures, case studies or slide shows are
Welcome (maximum 20 minutes, optional evenings). If so, please state your topic here:
8. If there is an agency or organization which will sponsor you for this course, please provide the
following information:
Name of sponsoring organization:
Contact Person:
Title:
Address:
Telephone:
Fax:
Email:
How to Apply
It is best to apply electronically. If you have access to this Application Form electronically, save the
form as a file on your computer, type in your information, save the file, and email a copy as an
attachment to the contact person listed below for the specific course you wish to attend. If you have
received this information in printed form, please return by fax or regular postal mail. You can also
apply directly by selecting the “apply online” option at www.phcetraining.org
American University of Beirut
Faculty of Health Sciences
Lebanon
Zeina Mohanna
Asian Disaster
Preparedness Center
Thailand
To be announced
Janette Lauza-Ugsang
Instructor of PH Practice
Faculty of Health Sciences
American University of Beirut
P.O. BOX 11-0236
Riad El Solh 1107 2020
Beirut, Lebanon
Tel: (961-1) 374 374 Ext. 4627
Fax: (961-1)744 470 (Attn: PHCE)
Mob: (961-3) 970 900
Email: zeina.mohanna@aub.edu.lb
Project Manager
Public Health in Emergencies
(PHE)
Asian Disaster Preparedness
Center
979/66-70, 24th Fl., SM Tower,
Paholyothin Rd.
Samsen Nai, Phayothai
Bangkok, Thailand 10400
Tel: (66-2) 298-0681 TO 92,
Ext 404
Fax: (66-2) 298-0012 to 13
Email: janette@adpc.net
Website:http://fhs.aub.edu.lb/phce
Website: http://www.adpc.net
Click Trainings and Workshops
Click on Continuing Education
Makerere University
School of Public Health
Uganda
nd
2
– 14th Nov 2015
Hanifah N. Bukirwa
Makerere University School of
Public Health
Mulago Hospital Complex
P.O. Box 7072,
Kampala, Uganda
Tel: (256-41) 543872,
(256-41) 263158/9
Fax: (256-41) 531807
Mob:(256-77) 492941
Email:
hbukirwa@musph.ac.ug
hbukilwa@gmail.com
(+256782036721)
Website:http://www.musph.ac.ug
Click on Upcoming Events
Application Deadline
Applications should be submitted as soon as possible and at least one month before the start
of the chosen course. They will be accepted on a rolling basis until the course is full. Course
organizers will review applications, and notification of status will be sent as soon as possible. Upon
registration and receipt of payment, applicants will receive detailed information concerning pre-arrival
reading assignments and logistical details, etc.
Tuition and Cancellation Policy
Tuition for the course is $2,400 which includes course fees, accommodation, all meals, and reading
and reference materials. Tuition is $1600 for locals who do not require accommodation. The tuition
includes a non-refundable registration fee of $250.
This course has been developed in conjunction with World Education, Inc., the International Rescue Committee and
Columbia University with support from the U.S. Office of Foreign Disaster Assistance/USAID
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