ICT@INNOVATION's TOT Online Institution Application Form

Webform Submitted by fredericky on 9. April 2009 - 12:28.

ICT@INNOVATION's Training of Trainers on

"FOSS Business Models for Africa"

Online Application Form for Institutions

Deadline for the Idelolo pre-conference training (14-15 May 2010)

is 14th April 2010!

Institutional Information

Name of Institution: *

Please do provide the full name of your institution or organisation.

Date of Establishment: *

Institution's ownership type: *

Institution's website http://:

Contact Address

Address Line 1: *

Address Line 2:

State / Province: *

Zip / Postal Code:

Country: *

Main Contact Information

The person named here will be the main contact point if further information is required.

Name: *

Position/Rank : *

E-mail: *

Phone/Mobile Number: *

Please include your country code

Countries of Operation

Please provide up to three (3) countries where you operate.

Country 1: *

Country 2:

Country 3:

Institutional Expertise and Affiliations

Please give a brief introduction to your institution or organisation. Please focus on how your organisation is reaching out to IT companies and/or IT professionals (300 words max.): *

Do you operate as a :

business support

IT support

training organisation

educational institution with business/IT programmes

Please explain briefly how you intend to incorporate FOSS trainings in your business services/training offerings/curricula (300 words max) : *

How do you plan to integrate a course on “African Business Models” into your training outreach portfolio? Or How do you plan to incorporate the programme in your IT-business/entrepreneurship programmes/curricula? (300 words max): *

Please describe how your institution or organisation intends to organise at least two trainings along the lines of this course in your country during 2010 (300 words max): *

Are you a member of any IT or Business Association? If yes, please list them:

Your Nominations for the ICT@INNOVATION training

Please provide up to three (3) nominees for the training. Note that there is no guarantee that all will be accepted. All nominees must fill in the application form for individuals, available online at: http://www.ict-innovation.fossfa.net/call/individuals

First Nominee: Name: *

First Nominee:E-mail: *

Second Nominee: Name:

Second Nominee: E-mail:

Third Nominee: Name:

Third Nominee: E-mail:

Are you able to offer institutional support to the participation of these nominees in the Training-of Trainer courses? Please name which:

Institutional Support

Participants or their institutions will need to bear travel costs to the training site, as well as make a contribution of 50 US Dollars towards training costs to InWEnt/FOSSFA.

Declaration

By submitting this form you are declaring that the information submitted is correct to the best of your knowledge.
It is important to us that your privacy is respected when we process personal data. By submitting this form you agree to the processing of such data only for any purpose connected with your application for this programme. These personal data will only be stored in our internal systems and will not be passed to third parties.
If you are not yet a member, please register here to become a member of ict@innovation's web community: www.ict-innovation.fossfa.net/user/register).Also, please make sure to also update information on your personal profile (login here), if you are already a registered user on ict@innovation.
Thank you very much for responding to this call for participation. Please complete your application by pressing "submit" (below).
An email will be sent to the address you provided in the "Main Contact Information section" and the various nominees automatically.

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ict@innovation is a programme of: