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Date Received: .................................
Personal Summary
Name in English: Permanent Home Address:
Name in Khmer:
Gender: □Male □Female
Photo
Date of Birth (DD/MM/YY): / /
4x6
Mobile Phone:
Email:
Skype:
Industry
Industry Name: Industry line:
□ Private □ NGO □ UN
Acronym:
□ Other (specify)....................................
Address: Office Telephone:
Office Email:
Your position:
Position: Email:
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People Living in Unified Society Training Team
□ Group I (full-time class): June 20-24, 2011 (7:30 am – 11:30 am and 1:30 pm – 5:30 pm)
□ Group II (weekend class): June 25-26, 2011 and July 2-3, 2011 and July 9, 2011 (7:30 am –
11:30 am and 1:30 pm – 5:30 pm)
□ Group III (part-time class): June 20-23, 2011 and June 27 - 30, 2011 and July 4-7, 2011 and July
11-14, 2011 (6:00 pm – 8:30 pm)
In the year ahead, what sort of training courses do you think you really need?
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