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PROFILIANT FACULTY PROGRAMME

Faculty Program Description Faculty Program Application Form (PDF)

PERSONAL INFORMATION (Note that all fields are required)
FIRST NAME:
LAST NAME:
PHONE:
EMAIL:
DATE OF BIRTH:		SEX:
MARITAL STATUS :		CONFIRM EMAIL:
PLACE/COUNTRY OF BIRTH :		NATIONALITY:
EDUCATIONAL INFORMATION (Tertiary Only)
Institution attended:
Year of Graduation:
Degree/Certificate:
Institution attended:
Year of Graduation:
Degree/Certificate:
Membership of Professional Bodies:
Professional Certifications:
Current Vocation or Employment:
Subject Matter Area: (E.g.- Time Management or Motivation)
Have you developed any course material and/or presentation(s) on this subject matter area? YES NO (If you answered ‘yes’ to this question, please provide hard and softcopy documents of your presentation)
Did you license all or any part of the presentation from a 3rd party? YES NO
Was the PowerPoint presentation jointly developed between you and any 3rd party? YES NO
Do you have copyrights granted or owned by yourself on the work done? YES NO
Have you produced instructor materials and/or delegate materials for the subject mater areas you have listed? YES NO
Please provide name and title of programs/courses you teach:
Please provide name and titles of courses you may wish to develop:
Do you have any formal/previous teaching/facilitating Experience? YES NO
Do you have any consulting experience? YES NO
Are you flexible in taking facilitation/teaching assignments? YES NO
What is the minimum time notice you require for accepting facilitation/teaching assignments?	Less that 24 Hours:: 24-48 Hours :: 1-2 weeks:: 1 month:: Other::
Do you have any preferences for (Days of the week/Time Slots in a day) for taking facilitation/teaching assignments? YES NO
Are you willing to accept facilitation/teaching assignments outside of your current city of abode? YES NO
FORMAL APPLICATION
I formally apply to be registered into the Profiliant Faculty Program
I do not wish to be registered into the Profiliant Faculty Program
Full Names:
Signature:
Date

Notes:

Please attach Curriculum Vitae or Professional resume
A professional profile of not more that one A4 page, Microsoft Word document, typed with font size 12.
Current Pictures of self- your best portraits you would like to see on the dedicated web page for you
You may attach copies of membership certificates of professional bodies, as well copies of certificates for training & certifications you have achieved