EASTERN AND SOUTHERN AFRICAN
MANAGEMENT INSTITUTE
(ESAMI)
In Partnership with
STRENGTHENING SUPPLY CHAINS THROUGH MONITORING AND EVALUATION COURSE
Application Form
(Course Dates)
Please submit a duly completed application form to one of the addresses listed on the course
announcement or e-mail it directly to Marketing Department through e-mail mbd@esamihq.ac.tz.
PART ONE: BIO DATA
Name of Applicant:
Dr.
Mr.
Mrs. Ms.
Current Position/Title:
Employer Organization:
Address of Employer:
Contact Land Phone:
Fax:
Mobile:
Fax:
Mobile:
Town and Country of Residence:
Town and Country of Birth:
Contact details
E-mail Address:
Name of Institution/Organization sponsoring your participation:
Contact Address if different from employer address
Address of Employer:
Land Phone:
Fax:
Mobile:
2
PART TWO: WORK EXPERIENCE
1. How long have you been employed in your current position?
2. Administrative level: Circle the administrative level at which you principally work.
Central
Regional/Provincial
District
Other: please explain
3. In order for participants to benefit fully from this course, they should have previous training in
logistics, have you completed:
The three-week Supply Chain Management for Commodity Security Course
___Yes ___No (If yes, date of the training)______________________
OR have you completed
The one week Overview Course in Supply Chain Management for Commodity Security
___Yes ____ No (If yes, date of the training)______________________
4. If you answered NO to question 3 above, yet have had previous training in logistics, please
describe this training.
5. Have you received training in monitoring and evaluation previous to this course?
______Yes _______ No
If yes, please indicate the year and describe the training you received.
6. With which health program(s) do you principally work? (For example, reproductive health, AIDS
Control, Expanded Program for Immunization, etc.)
7. Please describe your specific job responsibilities as they relate to monitoring and evaluation of
logistics systems.
8. What are the two most serious problems you have observed in the logistics system(s) of the
institution(s) where you work? (Please be as specific as possible)
Note: Application / Nomination forms are due three weeks before course commencement
3
a.
b.
9. Please describe how you think the course will better enable you to manage or improve monitoring
and evaluation of the logistics system with which you work.
10. Are there any specific aspects of your job that you would like to see this workshop address?
PART THREE : SKILLS AND INVOLVEMENT
11. Language skills: Circle your level of fluency in English (speak/read/write)
Beginning
Intermediate
Advanced
Note: Application / Nomination forms are due three weeks before course commencement
Native Speaker
4
The chart found below lists the M&E activities covered during the course. To the best of your
ability, please check the appropriate column to indicate your current skill level and
involvement in the activities using the rating scales provided.
SKILL LEVEL
INVOLVEMENT LEVEL
1 = cannot perform this task with the skills I
currently possess
2 = can perform this task with assistance
3 = can perform this task without assistance
1 = not involved in planning/implementing this task
2 = infrequently involved in planning/implementing
this task
3 = routinely involved in planning/implementing this
task
Task
Skill Level
1
Describe basic M&E concepts and principles as they
relate to supply chain management and improvement
Identify M&E’s role in strengthening logistics system
performance and ensuring commodity security.
Select appropriate logistics indicators for evaluating
product availability and forecasting, procurement,
warehousing, and distribution performance.
Identify M&E tools that can be used to measure logistics
system performance, including the most appropriate ones
to use for differing situations.
Compare the benefits and challenges of routine data
monitoring versus annual or semi-annual data evaluation.
Utilize logistics information and data to make decisions
and take action to improve system performance
List key components of an M&E plan
Develop an M&E plan for a supply chain challenge
Propose follow-up actions to ensure that M&E plans are
implemented
Note: Application / Nomination forms are due three weeks before course commencement
2
Involvement
Level
3
1
2
3
5
PART FOUR: ADMINISTRATIVE CONCERNS
1. ESAMI has hotel facilities. Full board and lodging fees per day per person is US $45 only.
Bed and Breakfast costs US$36 per day. Indicate your preference below
I will lodge at ESAMI facility on full board
I will lodge at ESAMI on bed & breakfast only
Alternatively, there are several hotels in Arusha town offering low to high class services
where course participants can choose to lodge. Detailed information on hotel rates can be
provided on request.
2. If you have any other administrative questions or concerns, please list them below.
Signature……………………………………..
Date…………………………………
Note: Application / Nomination forms are due three weeks before course commencement
6
PART FIVE: SPONSOR:
I ……………………………….. in my capacity as ……………………………………………
Nominate …………………………………………………………….to attended the above
programme and I commit my organisation to pay to Eastern and Southern African
Management Institute (ESAMI) the total programme fees of US$....................................
On understanding that the fee does not include full board accommodation for the period
involved.
Signature……………………………………..
Date…………………………………
FOR OFFICIAL USE ONLY
Date Received………………… File Name………………………. Accepted/Rejected
Date acknowledged………………………… Date confirmed/Advised…………………
Signature………………………………
Date………………………………
Note: Application / Nomination forms are due three weeks before course commencement