Sierra Leone Frontline Field Epidemiology Training Program (SL- FETP)-Frontline
Course Application Form please complete all required information
Demographic Information
Name *
Email *
Address *
Phone number
Sex
Age
Employment Information
Job Title
District/Town
Department/Organisation
Number of years in public health/Government service
Information on Applicants Immediate Supervisor
Name
Title
Work location
Email
Phone Number
Information on Applicant's Education (start with highest)
Education Background
Are you involved in surveillance activities? please tick appropriate response
Have you been involved in national surveillance system? (IDSR,TB, Leprosy, HIV/AIDS,Malaria,NTDs. If yes, indicate your role(s) and number of years
List the trainings you have received in surveillance, outbreak response, contact tracing, IDSR etc.
List the outbreaks
Investigations you have been involved in
Number of years remaining in service
Support for field project
yes
no
Row 1
what kind of operational support do you have for your field work
Access to surveillance data
Allowed to participate in an outbreak
Time to complete field project
Access to computer at work
Support from supervisor's for training
Willing to support others in training
others specify
Cohort 8 Frontline workshop dates
Workshops and field work dates
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