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 Individuals Application Deadline is 22nd September 2010 for Eastern Africa And 15th November for Southern Africa

Personal Information: 1) 2)

Title:

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Mr

Mrs

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Miss

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Master

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Dr.

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Prof.

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Your Name: …............................................................................................................ (As it appears in your passport with Surname first)

3) 4)

Date of Birth: --------/---------/--------What is your gender? Male

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Female

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5)

Country of Residence: ........................................................

6)

Nationality: ......................................................................................... (Only residents from Ethiopia, Kenya, Tanzania, Uganda and Rwanda are eligible to apply.) For Southern Africa it is Mozambique, Malawi, Namibia, Zambia and Republic of south Africa.

7)

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

8)

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

9)

Contact Telephone Number: ............................................................. (please include country code)

10) Contact Mobile Number: ................................................................... (please include country code)

Your profile and outreach role Please provide information on your profile and future outreach role, as well as on your relevant work experience.

11)

Present Position /Affiliation:............................................................

11.a)

Name of Present Employer/Affiliation ......................................................................................................... …......................................................................................................

11.b)

Main areas of activity of employer / affiliated organization (Please particularly provide information on how your employer / affiliated organization is active as an: ICT and business association; University/ higher Education Institution with IT/business programmes; ICT training institution (public or private); FOSS association or group; IT SME with substantial outreach potential. Please also provide a link to the organisation's website)

…...................................................................................................... …...................................................................................................... …...................................................................................................... …...................................................................................................... …...................................................................................................... …...................................................................................................... 11.c)

Current Position (and previous positions, if applicable) …...................................................................................................... …...................................................................................................... …......................................................................................................

11.d)

Primary Responsibilities: (Please describe your profile as: A trainer with an ICT / business association or group; An ICT/ business lecturer at a higher education institution; A specialist / trainer with an ICT training institution (public or private);A manager of an ICT SME with outreach potential; A FOSS advocate with a FOSS association or group)

…...................................................................................................... …...................................................................................................... …...................................................................................................... …...................................................................................................... …...................................................................................................... 11.e)

Years with Employer: …...................

12)

Your outreach potential

12.a)

How will you pass on the knowledge you have gained in this training to other people? (Please describe how you plan to pass on the knowledge gained in the trainings to IT-companies and IT professionals in your country. Please provide information on how you are reaching out to IT-companies / IT professionals (e.g. as key clients of your trainings), or how you are working as a lead person in focus group activity or trainer with the possibility to access training facilities)

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

12.b)

How will you integrate the course into your training /outreach programmes ? (Please provide information on: how you plan to integrate a course on “Linux Professional Institute Certification” into your training/outreach portfolio and how you envisage to incorporate the course in the IT-business /entrepreneurship programmes/ curricula of your organization)

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

12.c)

How will you conduct at least two trainings based on the course in 2011? (If you are selected for participation in the training course, you will be expected to act as a trainer yourself afterwards. Please provide information on how you or your organisation plan to organise and conduct at least two trainings of your own based on the course in your country during 2011.)

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

13)

Track record and personal interest:

13.a)

What is your personal interest in the topics of this training course? (Please provide information on your personal interest in the LPI certification and learning outcomes of the programme and how you plan to run a business or training courses)

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

Information on major trainings you have delivered (Please provide information on your experience in ICT and/or business related training, or your experience as a lead person in focus group activity targeting ITcompanies / IT professionals.)

1. Title of training:…........................................................................ 2. Purpose of training:..................................................................... 3. Your Role:..................................................................................... 4. Duration: .................................................................................... 5. Number of Participants................................................................ 6. Description of Participants: ......................................................... 7. Location (place and country):...................................................... 8. Paid or free:................................................................................

1. Title of training:…........................................................................ 2. Purpose of training:..................................................................... 3. Your Role:..................................................................................... 4. Duration: .................................................................................... 5. Number of Participants................................................................ 6. Description of Participants: ......................................................... 7. Location (place and country):...................................................... 8. Paid or free:................................................................................

13.c)

Name of Previous Employer: ........................................................................................................ ….....................................................................................................

13.d)

Primary Responsibilities: (Please describe how you have at least two years of professional experience in ICT and / or business development and/or experience in training, or as a lead person in focus group activity targeting IT-companies / IT professionals)

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13.e) 13.f)

Years with Employer:................................................................... List of Languages Spoken and Written Proficiently: …...................................................................................................... …...................................................................................................... …...................................................................................................... …......................................................................................................

13.g)

Linux Experience: Please describe your experience in administering a Linux PC. What exactly did you do?

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13.h)

How many years of experiences do you have with Unix/Linux system administration : ......... ..........................................................

13.i)

Do you have experiences with LPIC? Please name which: …...................................................................................................... …...................................................................................................... …......................................................................................................

…....................................................................................... ............... 14)

Relations to professional associations: Yes

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14.a)

Are you a member of FOSSFA?:

14.b)

Are you part of any other FOSS network?:

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No

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14.c)

Other comments and information on community registration: (If you have any other comments or additions, please list them below. Also, please make sure to update information on your personal profile here: www.ictinnovation.fossfa.net/search/user_advanced, if you are already a registered user on ict@innovation. If you are not a member yet, please register here to become part of ict@innovation's web community: www.ict-innovation.fossfa.net/user/register

…...................................................................................................... …...................................................................................................... …...................................................................................................... …...................................................................................................... 14.d)

Will you be able to bear the travel costs to Nairobi? If not, please provide reason. …...................................................................................................... …...................................................................................................... …...................................................................................................... …......................................................................................................

Application Deadline is 22nd September 2010!

Note: • Please attach your most recent Curriculum Vitae (C.V.) to this application. • Please attach a letter of recommendation to this application. • All documents must be in the following formats DOC, ODT or PDF

• Send this Application via email to: [email protected] and copy [email protected] or fax it to: +27-86-624-9181 Note: 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 two exams that make up LPIC-1, each costing about USD 95. Subsidies for travel may be granted upon request and justification. 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:.............................