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Local Democracy and Development (batch 1)
Course Dates :
Module 1 : Feb 07 - Feb 12, 2022 (Face to face)
Module 2 : Apr 02 - May 07, 2022 (Online - 6 Saturday's only)
Module 3 : Jun 13 - Jun 18, 2022 (Face to Face)
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Email
*
Your email
1. Full Name
*
(This is the name which will appear on the Certificate of Participation)
Your answer
2. Age
*
(Please select one)
Choose
26-30
31-35
36-40
41-45
46-50
51 and above
3. Gender
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Male
Female
Other
4a. Postal Address
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Your answer
4b. City
*
Your answer
4c. State
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Your answer
4d. PIN Code
*
Your answer
5. Mobile Number
*
Your answer
6. Government ID Proof
*
(Select any one of the following)
PAN
Election ID
Aadhar ID
Driving Lience
Passport
7. ID proof Number
*
Your answer
8a. Educational Qualification
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(Please write the University degree)
Your answer
8b. Area of Specialisation
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Your answer
9. Name of the organisation you represent
*
Your answer
10. Organisation’s Website
*
Your answer
11. Your Designation
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Your answer
12. Type of Organisation
*
Field-based organisation
International OR national grant making agency
Policy advocacy organisation OR Thinktank
Media
Social movement
Educational OR research institutions
Corporate Social Responsibility
Independent consultant
Other:
13. Work experience (Please confirm that you have a minimum of seven years of professional experience in the Development Sector)
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Yes
No
14. Domain of work/experience (Please describe)
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Your answer
15. The medium of instruction of this course is English. Please confirm that you are comfortable to attend the course
*
Yes
No
16. Why is participating in this course on 'Local Democracy and Development' important to your organisation and to you?” (Please answer within 400 words)
*
Your answer
17a. Will you need University arranged accommodation?
*
(Please note: University can arrange accommodation for a total cost of Rs. XXXX/- for both modul1 & 3 of the program, upon advance payment).
Yes
No
17b. If yes, please specify – Date and Expected time of arrival (for module1)
*
Your answer
17c. If yes, please specify – Date and Expected time of departure (for module1)
*
Your answer
18. Course Fee
*
(I am aware that if my application is accepted, I have to pay a course fee of)
Rs. XXX/- (for the entire course with taxes)
I represent Field Practice Partner of Azim Premji University. (Fee waiver is available for Field Practice Partners of University)
Confirmation
*
I am aware that all other costs, including boarding, lodging, meals, and travel, have to be borne by my organisation.
Required
Note :
If your application is accepted, we will email payment instructions to the email ID provided in this form.
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