Surname
Title
First Name
Age
Preferred First Name
Gender
Postal Address
Country Code
Area Code
Telephone Number
CONTACT DETAILS DURING DECEMBER and JANUARY (if different from above):
Cell/Mobile Number
Postal Address
Country Code
Area Code
Work Email Address
Home Email Address
Next of Kin Details:
Name
Relationship to you
Tel Number
Cell Number
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HIGHEST ACADEMIC QUALIFICATIONS FOR WHICH SARETI PROGRAMME ARE YOU APPLYING?
Degree Programme (takes 2 years to complete, of which 10–12 months are on campus)
Master of Social Science (M Soc Sci)
Self-funded students only
Non Degree Programme (each module requires 1 week's full-time attendance)
Stand alone ethics modules
INDICATE YOUR SCHOLARSHIP STATUS & REQUIREMENTS
I will require a full SARETI scholarship; please motivate:
I will require a partial SARETI scholarship; please motivate:
I am self-funded and need no SARETI scholarship:
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What is your home language? PLEASE INDICATE YOUR LANGUAGE PROFICIENCY (ORAL & WRITTEN) ON THE TABLE BELOW
Note: SARETI teaching is conducted entirely in the English medium and poor English proficiency on arrival may lead to early disqualification from the programme.
DESCRIBE YOUR PRESENT WORK and STUDIES specifically in relation to this application:
Present EMPLOYMENT:
Present POSITION / DUTIES / FUNCTIONS:
Describe your own EXPERIENCE in HEALTH RESEARCH:
Describe your own EXPERIENCE in the ETHICAL REVIEW of HEALTH RESEARCH:
Describe your own EXPERIENCE in TEACHING / LEARNING of RESEARCH ETHICS:
HOW WILL SARETI TRAINING BE OF USE TO YOU AND/OR YOUR INSTITUTION after you return home?
HOW WILL SARETI TRAINING ADVANCE YOUR CAREER in HEALTH RESEARCH ETHICS?
IF EMPLOYED: Describe the INSTITUTIONAL SUPPORT you are getting from YOUR EMPLOYER DURING and AFTER the SARETI COURSE WORK (attach supporting letter from employer):
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Please indicate a Research Ethics Committee in your home country where you will volunteer your expertise learned during SARETI for at least a 3-year period? Describe your PROPOSED TOPIC for RESEARCH THESIS/DISSERTATION. Please motivate your choice:
Please provide the Names, Addresses, E-mail addresses, and Telephone Numbers of TWO referees, of which at least one must be an academic, whom we can contact to request a confidential report on your suitability for this programme.
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WITH YOUR APPLICATION --- PLEASE ATTACH THE FOLLOWING:A brief CURRICULUM VITAE (not more than 5 pages).
A 2-page essay (not more) MOTIVATING YOUR CHOICE IN RESEARCH ETHICS TRAINING.
A LETTER FROM YOUR EMPLOYER specifying:
- Support for your proposed course of study
Copies of selected publications of yours in health research (maximum of 5).
Photocopies of your Degree Certificates and Academic Transcripts (NB Certified copies or originals will be needed later on when you formally register at UKZN).
Certified copy of your Passport.
APPLICATION FOR EVALUATION OF CREDENTIALS (non-South African Honours / 4-year degree):
If you have obtained your degrees at institutions outside of South Africa, you MUST APPLY to the South African Qualification Authority (SAQA) for evaluation of your credentials at:
Postnet Suite 248
Private Bag X06
WATERKLOOF
0145
South Africa
Tel: +27 12 4315000 or http://www.saqa.org.za
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