APPLICATION FORM
INTERNATIONAL WORKSHOP ON INTRODUCTORY TO ADVANCED LEVEL STATISTICS FOR HEALTH AND SOCIAL SCIENCE RESEARCHERS FOR NATIONAL DEVELOPMENT
(8th - 19th January, 2018 - Accra, Ghana)
Sex
Title
Family name (IN CAPS)
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Other names
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Current position/job title
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Institutional affiliation
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Institutional mailing address
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Business telephone
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Home telephone
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E-mail address
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Nearest airport
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Country of citizenship
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City & country of birth
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Country of legal permanent residence
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Date of birth
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Country of passport (international applicants only) - if different from country of citizenship
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Accommodation required
Post-Secondary Education
(Begin with most recent and include relevant short-term technical or professional training)
Date completed (1)
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Institution attended (1)
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Major subject (1)
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Degree completed (1)
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Date completed (2)
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Institution attended (2)
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Degree completed (2)
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Date completed (3)
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Institution attended (3)
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Major subject (3)
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Degree completed (3)
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Relevant work experience
(Begin with most recent employment, and include all current jobs. If additional information is available separately, mailto:staphnadgh@gmail.com
Date started (1)
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Employer (1)
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City/Country (1)
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Date started (2)
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Employer (2)
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City/Country (2)
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Date started (3)
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Position/Title (3)
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Employer (3)
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City/Country (3)
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In which type of organization do you currently work?
How many years in total have you been working professionally?
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Students only
Name of Institution
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Programme of Study
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Current Year
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Student ID No.
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Payment Information
Account Name: D&D Statistical Consulting Services
Account No.: 1050325985013
Bank Name: Fidelity, UPSA Branch
Swift Code: FBLIGHAC
Address: PMB 43, Cantonment, Accra

For further enquiries contact: staphnadgh@gmail.com

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