THE ASSOCIATION OF AFRICAN UNIVERSITIES IN COLLABORATION WITH SAIDE
PILOT ONLINE COURSE FOR UNIVERSITY LEADERS ON
RETHNKING PROFESSIONAL DEVELOPMENT FOR ACADEMICS

Registration Form

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1. Title/Titre (Required.)

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2. Surname/Nom (Required.)

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3. Other Names/Prénoms (Required.)

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4. Gender/Sexe (Required.)

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5. State your discipline/Specialist area

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6. Position/Poste (Required.)

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7. Name of Institution/Non de l’Institution (Required.)

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8. Is your institution an AAU member?

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9. Address/Adresse

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10. City/Ville (Required.)

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11. Country/Pays (Required.)

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12. Telephone Number (with City Code where applicable)/No. de tel. (avec le préfixe s’il y lieu) (Required.)

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13. Email Address/Adresse email (Required.)

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14. What would you want to be emphasised for your benefit during this workshop?

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15. What else would you want to be learn about besides the content that is being covered?

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16. How did you get to know of the pilot workshop? (Select more than one avenue if it applies in your case) / Comment avez-vous eu connaissance de ces ateliers? (Sélectionnez plus d'une voie, le cas échéant) (Required.)

Newspaper Advertisement / Publicité sur les journaux

Direct Email / Courrier électronique direct

AAU Newsletter / Bulletin de l'AUA

Phone Call / Appel téléphonique

AAU Websites: aau.org or blog.aau.org / Sites Web de l'AUA: aau.org ou blog.aau.org

Social Media / Médias sociaux

Bulk SMS / SMS groupés

Word of Mouth / Bouche à oreille

Other (please specify) / Autre (veuillez préciser)

THANK YOU | MERCI

Question Title

* 1. Title/Titre (Required.)

Question Title

* 2. Surname/Nom (Required.)

Question Title

* 3. Other Names/Prénoms (Required.)

Question Title

* 4. Gender/Sexe (Required.)

Question Title

* 5. State your discipline/Specialist area

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* 6. Position/Poste (Required.)

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* 7. Name of Institution/Non de l’Institution (Required.)

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* 8. Is your institution an AAU member?

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* 9. Address/Adresse

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* 10. City/Ville (Required.)

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* 11. Country/Pays (Required.)

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* 12. Telephone Number (with City Code where applicable)/No. de tel. (avec le préfixe s’il y lieu) (Required.)

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* 13. Email Address/Adresse email (Required.)

Question Title

* 14. What would you want to be emphasised for your benefit during this workshop?

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* 15. What else would you want to be learn about besides the content that is being covered?

Question Title

* 16. How did you get to know of the pilot workshop? (Select more than one avenue if it applies in your case) / Comment avez-vous eu connaissance de ces ateliers? (Sélectionnez plus d'une voie, le cas échéant) (Required.)

1. Title/Titre (Required.)

2. Surname/Nom (Required.)

3. Other Names/Prénoms (Required.)

4. Gender/Sexe (Required.)

5. State your discipline/Specialist area

6. Position/Poste (Required.)

7. Name of Institution/Non de l’Institution (Required.)

8. Is your institution an AAU member?

9. Address/Adresse

10. City/Ville (Required.)

11. Country/Pays (Required.)

12. Telephone Number (with City Code where applicable)/No. de tel. (avec le préfixe s’il y lieu) (Required.)

13. Email Address/Adresse email (Required.)

14. What would you want to be emphasised for your benefit during this workshop?

15. What else would you want to be learn about besides the content that is being covered?

16. How did you get to know of the pilot workshop? (Select more than one avenue if it applies in your case) / Comment avez-vous eu connaissance de ces ateliers? (Sélectionnez plus d'une voie, le cas échéant) (Required.)