Operational Research Course: Union, Paris, 2012 – 2013

Application Form

 

 

 

Module 1a:    Research questions and protocol development

9 – 13 July 2012

Module 1b:    Data management and data analysis

16 – 20 July 2012

Module 2:      Paper writing

3 – 7 June 2013

 

 

International Union Against Tuberculosis and Lung Disease

68, Boulevard Saint Michel

75006 Paris

France

 

 

1. 1.     Applicant Information

Please fill in your name exactly as it appears on your passport.

 

Title:  Prof   Dr    Mr    Ms                                               Male     Female

 

Family name (surname) …………………………. First (given) name ……………………………

Home address …………………………………………………………………………………………………

………………………………………………………………… City (+city code)        Country ……………………………………………

Tel ………………………………………………….. Fax…………………………………………………..

E-mail ……………………………………………….

 

Place of work  ………………………………………………………………………………………………….

Work address……………………………………………………………………………………………………………

City (+city code)………………………………… Country ……………………………………………

Tel ………………………………………………….. Fax ………………………………………………….

E-mail ……………………………………………….

 

 

 

 

Citizenship (passport) …………………………… Passport N°………………………………………

Date of birth ……………………………………………………………………………………………………..

Place of birth (city, country)………………………………………………………………………………..

 

Current Profession (Job title): ………………………………………………………………………..

 

Job Description:

 

1. 2.     Knowledge of English

Spoken:                               Excellent      Good       Average

Written:                               Excellent      Good       Average

 

Up to what level have you studied English? * ………………………………………………………….

Number of years? ……………………………………………………………………………………………….

* elementary school, secondary school, college/university, professional

 

1. 3.     Computer Literacy

Word:                                     Proficient   Intermediate  Beginner    Never used

Excel:                                     Proficient   Intermediate  Beginner    Never used

Internet:                                  Proficient   Intermediate  Beginner    Never used

Epi Info/EpiData:                     Proficient   Intermediate  Beginner    Never used

 

How often do you use the computer in a week? ……………………………………………………..

How many hours in a day do you use the computer?……………………………………………….

 

Kindly note that all participants are required to bring a laptop (Windows compatible, English keyboard) to the course

 

Being computer literate means daily usage of and familiarity with your PC Windows laptop. You are required to have (i) an up-to-date patented virus protection software (ii) proficiency in file and folder management, (iii) knowledge of computer organisational structure, (iv) familiarity with the role and concept of file names and extensions, (v) ability to set up display of relevant file information (file name, extension, size, and date), (vi) understanding short-cut keys and using these for efficient copying, pasting, searching and replacing file elements, (vii) openness to learn new methods to improve.  No prior knowledge of course software is required.  You are only eligible if you understand this paragraph.

 

 

 

 

1. 4.     Have you ever attended other operational research training programmes or courses? 

Yes    No

If yes, please indicate the name of the programme:

Year ……………………… Conducted by (organisation) ………………………………………………..

             

 

1. 5.     Supervisor (Programme Manager/Medical Director)

Name………………………………………………………………………………………………………………….

Title…………………………………………………………………………………………………………………….

Organisation………………………………………………………………………………………………………..

Address……………………………………………………………………………………………………………..

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

City (+ city code)……………………………………… Country……………………………………………..

Tel………………………………………………………….. Fax……………………………………………………

E-mail  ………………………………………………………………………………………………………………. .

1. 6.     Mentor (Experienced technical adviser at country level, who will take charge, guide and support the applicant)

Name………………………………………………………………………………………………………………….

Title…………………………………………………………………………………………………………………….

Organisation………………………………………………………………………………………………………..

Address……………………………………………………………………………………………………………..

City (+ city code)……………………………………… Country……………………………………………..

Tel………………………………………………………….. Fax……………………………………………………

E-mail  ………………………………………………………………………………………………………………. .

 

1. 7.     Sponsorship 

The Centre will provide a full scholarship which includes all tuition fees, travel expenses, meals and accommodation.

 

 

 

Please send with your Application Form the following documents: 

• Typewritten detailed Curriculum Vitae
• Written statement confirming your commitment:

ü  to participate in all three course modules, return to your current disease-control programme or health institution following the course, and apply the knowledge gained

ü  to mobilise the funds required to carry out operational research at programme level during the course

• Written statement from your direct supervisor/officer attesting to the investment of resources, and the granting of permission for you to have the time and opportunity to carry out operational research within the programme
• Written statement from your mentor describing how they know you and how they propose to support you to complete the course successfully
• ½ page of text that:

a)    describes a problem you have identified within your programme and

b)    formulates a research question that you propose to develop into an operational research project during the course. Please note that the research questions using routine programme data or already collected data are definitely preferred as prospective studies are unlikely to fit into the time-line and expected outputs of the course. (you may have already begun such research, in which case you should describe what you have started and how you intend to continue)

 

Application Deadline: 31^st March 2012

 

 

Applicant’s signature:……………………………………..   Date: ……………………………………………………

 

Send your complete application by fax, e-mail or post to:

 

Ms Cécile Sevel, Course Coordinator

International Union Against Tuberculosis and Lung Disease (The Union)

Centre for Strategic Health Information and Operational Research

68, boulevard Saint-Michel, 75006 Paris,  FRANCE

Tel: (+33) 1 44 32 03 60   Fax: (+33) 1 43 29 90 87

E-mail: [email protected]

 

Results of the selection process will be communicated to all applicants by the end of April 2012.

Failure to provide all of the above requested information may result in the rejection of your application.

Special thanks to our collaborating partner Médecins Sans Frontières – Brussels Operational Centre, Luxembourg