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Appliaction Form for Coursera Online Learning Opportunity
1. Personal Details
Full Name
*
First
Last
Email Account
*
Phone Number
*
Date of Birth
*
Gender
*
female
male
Do you consider yourself disabled?
*
yes
no
District of Residence
*
Sector of Residence
*
2. Employment Situation
Employment Status
*
Employed
Unemployed
Reason for Unemployment
*
I was employed in the past but am currently unemployed (reasons are not related to COVID 19)
I have recently lost my job/source of income due to COVID 19
I was never employed and am currently looking for a job
not unemployed
If you are unemployed, please provide us some details to assess your suitability for the scholarship
Current Occupation
*
University Lecturer
TVET Teacher
Secondary School Teacher
Student
Self-employed
Other
3. Education and Skills
Level of Education
*
PHD
Masters Degree
Bachelors Degree
Diploma
Technical Studies
High School
Field of Studies
English Language Proficiency
*
Basic
Intermediate
Fluent
4. Connectivity
This is an online learning opportunity. Participants need an internet connection and device! The courses can be accessed through smartphone, tablet, desktop or laptop.
Do you have access to internet?
*
yes
no
How would you access Coursera if you are selected?
*
Smartphone
Tablet
Laptop
Desktop PC
Consent
*
Yes, I give my consent
No, I wish to opt out
We would be forwarding your email address to Commonwealth of Learning and to Coursera for inviting you to the COL-Coursera-RTN Workforce Recovery Program. Please tick one of the following to offer your consent to the same. You can opt out if you do not like your email to be forwarded to them.
Declaration
By submitting this form, I certify that all information contained in this application form are true and complete. I also commit to complete at least two courses on Coursera learning platform.
Comments
This field is for validation purposes and should be left unchanged.
Home
About
Services
E-government Services
Internet / 4G LTE Services
Financial Services
Online learning opportunity
Partner with us
News
Contact
become an agent
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