Epuka Ugaidi Organization Virtual P/CVE Training Registration Form Survey

1.First Name:(Required.)

2.Last Name:(Required.)

4.Gender:(Required.)

Female

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5.Phone Number: Please start with County Code eg (+254)(Required.)

6.Email address:(Required.)

7.Country of Citizenship:(Required.)

8.Country of Residence:(Required.)

9.Employment Status:(Required.)

Employed

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Unemployed

NOTE:

By applying to be a participant for Epuka Ugaidi training on “The Changing Dynamics of Violent Extremism in the Horn of Africa” you are consenting to the following:

1. I agree that, the information provided above will be held by Epuka Ugaidi ONLY as data and processed for statistical purposes;

2. I agree that, the outputs of the workshop will be shared to other researchers and interested professionals within the consortium;

3. I agree that, participation is voluntary, and I can choose not to participate in part or all of the project, and that I can withdraw at any stage of the project without being penalized or disadvantaged in any way;

4. I agree to the arrangements for data storage, archiving, sharing;

5. I agree to the use of anonymized quotes;

6. I agree to be kept updated with Epuka Ugaidi project activities and results through my contact above.

Epuka Ugaidi Organization Virtual P/CVE Training Registration Form

The Changing Dynamics of Violent Extremism in Horn of Africa