GHWEN — Global Health Workforce Economics Network

Human Resources in Health: Labor Markets Training Application

To apply for a seat in the course, please provide the below information. Early application submission is encouraged due to limited enrollment. Please submit the completed application with a curriculum vitae by April 15, 2010.

Required fields are highlighted in yellow or explicitly indicated.

Contact Information

Preferred Title Must not be empty.

First Name Must not be empty.

Last Name Must not be empty.

Company/Organization Must not be empty.

Title or Position Must not be empty.

Division (if applicable)

Address (Line 1) Must not be empty.

Address (Line 2)

City Must not be empty.

State/Province Must not be empty.

Zip/Postal Code Must not be empty.

Postal Office Box

Country Must not be empty.

Country of Citizenship Must not be empty.

Telephone Must not be empty.

Mobile Phone

Fax

E-Mail Address Must not be empty.

Assistant's e-mail

Education

Highest Level Completed Must not be empty.

University (if applicable)

Applicant's Professional Profile

What are your objectives for attending this program? Must not be empty.

Please describe your background or experience in the field of human resources in health. Must not be empty.

You may copy and paste your resume here (or if you prefer, send an electronic copy of your resume to amynuttbrock@berkeley.edu):

English Language Ability required

Pick one of the options above. English is my native language

My previous training has been in English

Financial Support required

You have to pick one of the options. If you will be sponsored you also need to fill in box on the right. I will be sponsored. Amount of Sponsor's Commitment: US$

My employer (company/country) will be paying

I will be paying

Payment Method required

You have to pick one of the options. Wire Transfer

Bank Check

Payer Information

Name of Organization Must not be empty.

Contact Person Must not be empty.

Street Address Must not be empty.

City, Zip Code, Country Must not be empty.

Telephone Must not be empty.

Fax

E-mail Must not be empty.

How Did You Hear About This Program? required

Pick only one option and fill in corresponding box on the right. A colleague. His/Her name:

Professional Association:

Advertisement in:

Through Internet search, found using:

Other, please explain:

Cancellation Policy

Written notification of cancellation or substitution must be received from the participant by the calendar day stated below.
If an applicant withdraws after being invoiced for enrollment more than 30 calendar days prior to the start of the program, the sponsoring organization is entitled to an 80% refund.
If an applicant withdraws 30-15 calendar days prior to the start of the program, the organization is entitled to a 50% refund.
No refunds are allowed if an applicant withdraws within 14 calendar days of the start of the program.
If the participant is unable to attend a program, the sponsoring organization may suggest an alternate and submit materials for the alternate no later that 7 days prior to the start of the program.
No refunds are given for any used portion of the program.
A $100.00 fee will be assessed for all returned checks.

When you click Submit, your data will be automatically transmitted to the School of Public Health. If your application is reviewed and accepted, you will receive a confirming e-mail and instructions about how to complete your payment in accordance with the payment option that you selected above.