PUBLIC HEALTH IN COMPLEX EMERGENCIES
TRAINING PROGRAM
APPLICATION FORM – 2010
March 8-20, 2010
Faculty of Health Sciences
American University of Beirut, Lebanon
Name:
Date of Birth:
Nationality:
Male/Female:
Permanent Mailing Address:
Current Work Address:
Email:
Alternative Email:
Work Telephone no:
Home/Mobile Telephone no:
Fax:
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
6. Please list your expectations from the Course:
Fair
Good
Excellent
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.
Faculty of Health Sciences,
American University
of Beirut
Lebanon
March 8-20, 2010
Ms. Zeina Mohanna
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)
Email: zeina.mohanna@aub.edu.lb
Website: http://fhs.aub.edu.lb
Click on Continuing Education
Asian Disaster
Preparedness Center
Thailand
Makerere University
Institute of Public Health
Uganda
2010- Date to be announced
Ms. Janette Lauza-Ugsang
Project Manager
Public Health in Emergencies
Asian Disaster Preparedness
Center
P.O. Box 4 Klong Luang,
Pathumthani
12120 Thailand
Tel. (66-2) 516 5900 ext 351
Fax (66-2) 524 5360 / 524 5350
Email: janette@adpc.net
Website:
http://www.adpc.net/v2007/
Click on Trainings and Workshops
2010- Date to be announced
Ms. Prima Nalubega Wasukira
Assistant Registrar
Makerere University IPH
Mulago Hospital Complex
P.O. Box 7072,
Kampala, Uganda
Tel: (256-41) 543872
Fax: (256-41) 531807
Mob: (256-77) 492941
Email: pnalubega@iph.ac.ug
P_nalubega@yahoo.co.uk
Website: http://www.iph.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 all
reading and reference materials. The tuition includes a non-refundable registration fee of $250.
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