APPLICATION FORM
2021 PROSAFE Online Courses
Mekong Institute, Khon Kaen, Thailand

Question Title

* 1. Which training course are you applying for?

Risk-based Approach to National Food Safety Control System (June 7-11, 2021)

Food Safety for Market Access (June 21-25, 2021)

Food Additives and Preservatives (September 6-10, 2021)

Safer Street Food Practices (October 18-22, 2021)

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* 2. Name (as shown in passport)

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* 3. Nationality

Cambodia

Lao PDR

Myanmar

Vietnam

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* 4. Gender

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* 5. Date of Birth

Date

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* 6. Contact Information

Email Address

Phone Number

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* 7. Position and Work Address (include department or section as relevant)

Position Title

Division and Department

Name of Organization

Address

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* 8. Brief Description of Your Work Duties and Responsibilities (within 150 words)

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* 9. What is your highest educational degree?

Doctorate

Master

Bachelor

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* 10. Please share the following information about your highest educational degree.

Degree Name

Year Completed

Institution Name

Country

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* 11. Proficiency of English

	Fair	Good	Excellent
Reading	Reading Fair	Reading Good	Reading Excellent
Writing	Writing Fair	Writing Good	Writing Excellent
Speaking	Speaking Fair	Speaking Good	Speaking Excellent
Listening	Listening Fair	Listening Good	Listening Excellent

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* 12. Curriculum Vitae (CV)

Please upload your updated CV or resume in pdf or word version

PDF, DOC, DOCX file types only.

Choose File

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* 13. Expectations: what do you expect to learn from this training course?

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* 14. Please briefly describe the action plan that you wish to implement after the training finished?

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* 15. Undertaking by the Applicant

I certify that my statements in this application are true, complete, and correct to the best of my knowledge and belief. I also fully understand that to be granted this opportunity is an honor and privilege requiring the responsibility of dutifully representing my country and organization.

APPLICATION FORM2021 PROSAFE Online CoursesMekong Institute, Khon Kaen, Thailand

Question Title

* 1. Which training course are you applying for?

Question Title

* 2. Name (as shown in passport)

Question Title

* 3. Nationality

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* 4. Gender

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* 5. Date of Birth

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* 6. Contact Information

Question Title

* 7. Position and Work Address (include department or section as relevant)

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* 8. Brief Description of Your Work Duties and Responsibilities (within 150 words)

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* 9. What is your highest educational degree?

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* 10. Please share the following information about your highest educational degree.

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* 11. Proficiency of English

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* 12. Curriculum Vitae (CV)

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* 13. Expectations: what do you expect to learn from this training course?

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* 14. Please briefly describe the action plan that you wish to implement after the training finished?

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* 15. Undertaking by the Applicant

APPLICATION FORM
2021 PROSAFE Online Courses
Mekong Institute, Khon Kaen, Thailand