LFR Course Application Form Online LFR Course Application Form Step 1 of 3 0% Contact Details Name* First Last Preferred Name Gender* Male Female Work/Organization Work/Organization Name Job Title Address Street Address City ZIP / Postal Code Phone Fax Mobile Email Home Address Street Address City ZIP / Postal Code Phone* Email* Application Process This application together with your Curriculum Vitae will be considered by the advisory group (a group of leaders with knowledge and experience in Mental Health Services in Libya). Upload your CV* Accepted file types: doc, pdf, docx. Please ensure to include education, training and courses, work experience. Note – all electronic documents must be provided in either .doc or .pdf format. If you have a disability that requires us to make a reasonable adjustment to enable you to apply please tick this box and we will contact you. Referee Please provide contact details of a referee. Name First Last Phone Email Please provide us with a brief biography that describes your professional role in Libyan mental health services – big or small – within your organization or community.* (350 words maximum) Describe your current work/voluntary or community activities which relate to Mental Health Libya, or your future aims and motivations for Libya. Also, what challenges are there that you will face? * (350 words maximum) Please explain what you think the most pressing challenges will be for the development of Mental Health Services in Libya. What role do you want to have in it and how will this course help you to play a part?* (350 words max) In what language(s) do you work? I am comfortable delivering training in English* Not at all Somewhat Very I am comfortable delivering training in Arabic* Not at all Somewhat Very I am comfortable following training in English* Not at all Somewhat Very I am comfortable following training in Arabic* Not at all Somewhat Very Please describe any special needs we should be aware of such as disability, dietary requirements etc… Duties and Responsabilites To attend all components of the course and complete summative and formative assessments in formal knowledge and practical skills. To actively engage in ongoing clinical supervision and to complete a supervision log. To actively participate in post training evaluation study To commit to the personal study requirements and complete log of the same. Prepare, or contribution to the preparation of, manuscripts for publication in peer-reviewed journals Actively participate in feedback and other meetings as appropriate Declaration and confirmation* I confirm that in submitting this application I declare that the information is correct to the best of my knowledge. Read our Terms and Conditions Terms and conditions* I have read and agree with the course terms and conditions.