Application for Smokeless Tobacco Online Certificate Course


Before you begin filling out this application, please note that there are several documents you will need. Please review the Documentation section below and make sure you have all the required documents before you start.




First Name (Given Name)*
Last Name (Surname or Family Name)*
Highest Degree (e.g. PhD, MD, MPH, ...)*
Institution *
Street Address *
City *
State *
Pin Code *
Mobile No: *
Preferred E-mail (format: abc@gmail.com) *
Alternate E-mail (format: abc@gmail.com)
Which of the following best describes you:

Research or Cancer Topics of Interest *
Please provide up to 6 keywords or phrases describing your research interests (e.g., Public health, Tobacco control, Cancer Prevention, Training, Cancer Control Planning, Cancer Surveillance etc.).

Interests required


Curriculum Vitae: required (Include complete work address, telephone, fax, and e-mail. ) *

Letter of Nomination/Recommendation: required Letter should be from the director of your institute or department,on official letterhead, and addressed to WHO FCTC Knowledge Hub SLT Summer Curriculum Committee.



Feedback
Please provide us with your feedback about the application process.Do NOT include any additional information about yourself. That information should be included in your curriculum vitae.No information included in this section will be provided to the reviewers for evaluation.You will NOT be evaluated on the information that you provide in this section.

feedback