Membership Application Form
Personal Information
Title
Name in full
Your answer
Address (Residential)
Your answer
Telephone No.
Your answer
Mobile
Your answer
E-mail
Your answer
Gender
Date of Birth
Your answer
Nationality
Your answer
National Identity Card/Passport Number
Your answer
Organizational / Work Place details
Name of the Organization
Your answer
Designation
Your answer
Address
Your answer
Telephone No.
Your answer
Mobile
Your answer
E-mail
Your answer
Academic & Professional Qualifications
Please e-mail a signed copy of your CV
Your answer
Have you received any of the following
Yes
No
Formal and specific academic training in program evaluation
On-the-job training in evaluation
Continuing education courses/workshops on evaluation
Occupational Focus
Select up to three
Major responsibility in present position
Select up to Three
To what extent are you involved in program evaluation in your present position
Select a one
Name of SLEvA member nominating you
Your answer
If not, please provide references from two professionals
Your answer
Preferred Membership Category
Under the revised Constitution, applications for membership are received under Individual, Institutional and Student categories, and the subscription fees applicable are Rs 2000/-, Rs 10,000/- and Rs 2000/- respectively. An Individual Member may be exempted from further annual subscription of Rs 2000/- on a one-time payment of 05 years’ Individual membership subscription fee. An Institutional Member is required to renew membership once in every 05 years.
What are your expectations by joining SLEvA
Your answer
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