Training of Trainers on “FOSS Certification” (Linux ... - ict@innovation

Training of Trainers on “FOSS Certification” (Linux Professional Institute Certification level 1) for East Africa and Southern Africa Application Form for Institutions Application Deadline is 22nd September 2010 for Eastern Africa And 15th November for Southern Africa

Institutional Information: 1)

Name of Institution: ..............................................................................

2)

Date of Establishment: --------/---------/---------

3)

Institution's Ownership Type: ................................................................ (Private/Public/Public-private partnership)

4)

Institution's Website: http:// .................................................................

5)

Postal Address / Street Address: ............................................................ ......................................................................................................... ........................................................................................................

6)

Main Contact Information:

6.a)

Main Contact Name: .......................................................................

6.b)

Position/Rank: ..................................................................................

6.c)

E-mail Address: ...............................................................................

6.a)

Contact Mobile Number: ................................................................. (please include country codes)

7)

Countries of Operation: (Please list maximum three (3)):

7.a)

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7.b)

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7.c)

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(Only businesses and institutions operating within Ethiopia, Kenya, Rwanda, Tanzania, Uganda and Rwanda are eligible to apply for the Easter African training.) For Southern Africa it is Mozambique, Malawi, Namibia, Zambia and Republic of south Africa.

Institutional Expertise and Affiliations: 8)

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. …...................................................................................................... …...................................................................................................... ......................................................................................................... …...................................................................................................... ......................................................................................................... .........................................................................................................

9)

Do you operate as a

□ business support □ IT support □ training organisation □ educational institution with business/IT programmes □ business, ICT or FOSS association or group 9.a)

Please explain briefly how you intend to incorporate FOSS trainings in your business services/training offerings/curricula: ….................................................................................................... …...................................................................................................... …...................................................................................................... …......................................................................................................

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…...................................................................................................... .........................................................................................................

10) Please describe how your institution or organisation intends to organise at least three trainings along the lines of this course in your country during 2011: …............................................................................................................. …............................................................................................................. …............................................................................................................. …............................................................................................................. …............................................................................................................. …............................................................................................................. …............................................................................................................. …............................................................................................................. 11) How do you plan to integrate a course on “Linux Professional Institute Certification” into your training outreach portfolio? …............................................................................................................. …............................................................................................................. …............................................................................................................. …............................................................................................................. …............................................................................................................. …............................................................................................................. …............................................................................................................. …............................................................................................................. …............................................................................................................. 12) Are you a member of any IT or Business Association? Yes 12.a)

□

□

No

If YES, please list: …...................................................................................................... …..................................................................................................... …......................................................................................................

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…...................................................................................................... 13)

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/lpi_tot_call/individuals

14) First Nominee Name:................................................................................................. 14.a)

E-mail:.......................................................................................

15) Second Nominee Name:............................................................................................. 15.a)

E-mail:.......................................................................................

16) Third Nominee Name.......:......................................................................................... 16.a)

E-mail:.......................................................................................

17) Are you able to offer institutional support to the participation of these nominees in the Training-of Trainer courses? Please name which: .................................................................................................................... .................................................................................................................... .................................................................................................................... …................................................................................................................. …................................................................................................................ Note: •Send this Application to: [email protected], and copy [email protected] or fax it to: +27-86-6249181 by 22nd September 2010

•Participants or their institutions will need to bear travel costs to the training site, as well as make a commitment to book and sit the LPIC exams (two exams) costing about 95 USD each. Subsidies for travel may be granted upon request and justification. ToT Application Form

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Declaration: By submitting this form you are declaring that the information submitted by you 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 program. These personal data will only be stored in our internal systems and will not be passed to third parties.

Signature …..................................

Date:........................

Join ict@innovation and become a community member! We would like to ask you to become a member of the ict@innovation community by registering on the ict@innovation website and creating a profile, indicating your interests and skills in FOSS. This will enable you to contribute to the Website Fora and Wikis, to join in a knowledge exchange with other persons interested in FOSS and/or involved in the ict@innovation programme. Please register here: www.ict-innovation.fossfa.net/user/register

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