Rozan: M&E Capacity Building

M&E/CB-05

Participant Profile Form

Program: Zeest-Women’s Program

Workshop name: 3-day Training on Psychosocial Support for GBV Survivors with Special Focus on Women
with Disabilities
Dates: 8th-10th June, 2021
Venue: Virtually through Zoom

Personal Details
Name……………………………………………………………………………………
Postal Address: ………………………………………………………………………..
Telephone: …………………………………… Cell: ……………………………………
Fax: …………………………………….
E-mail: …………………………………………………………………………………..
Education: …………………………………………………..
Any Disability (explain if some special requirements)…………………………………………………..
Name of the Organization/Government Institution: ……………………………………………………..
Designation: ………………………………………………………………………..
Description of your work: …………………………………………………………..
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Work Experience:
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Please indicate how this workshop will be useful in your professional life.
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What are your expectations from this workshop?
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Applicant’s Signature: ________________________________ Date: _________________________

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