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Application for Henrikje Klasen iCAMH Junior Trainers
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Name
Your answer
Email address
Your answer
(expected) date of qualification as child psychiatrist
Your answer
Country
Your answer
Institution
Your answer
Current position
Your answer
Why would you like to be an Henrikje Klasen iCAMH Trainer? Please describe your motivation as well as any relevant experiences including any periods living and working in LAMIC
Your answer
What are your language skills? The slides and course material currently only exist in English, but the training can be given in any language.
English
Mother tongue
Very good
Good
Moderate
Basic
Clear selection
Spanish
Mother tongue
Very good
Good
Moderate
Basic
Clear selection
French
Mother tongue
Very good
Good
Moderate
Basic
Clear selection
Arabic
Mother tongue
Very good
Good
Moderate
Basic
Clear selection
Other (specify)
Your answer
Mother tongue
Very good
Good
Moderate
Basic
Clear selection
Other (specify)
Your answer
Mother tongue
Very good
Good
Moderate
Basic
Clear selection
___________________________________________________________
Do you have any experience of teaching child psychiatry
Yes
No
Clear selection
Please give details
Your answer
Do you have any teaching qualifications (e.g. teach the teacher courses).
Yes
No
Clear selection
Please give details
Your answer
Do you have any further qualifications or sub-specialties apart from CAP?
Research experience for evaluation of course
PhD
Psychotherapy training
Forensic Psychiatry
Addictions
Epidemiology
Management/health service development
Other
If you have details, please feel free
Your answer
Please send a CV and a letter of support from your head of training or head of institution to
info@iacapap.org
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