Resource Person Certificate Form

Registration for Selection and Empanelment of Master Resource Persons

CategoryOfficialNGOERsFreelancer

State:

Name:

Sex:MaleFemale

DOB:

Address for correspondence:

Phone Number:

Email ID:

Aadhar Number:

Highest Academic Qualifications:

Language Proficiency:EnglishHindiOther

Present / Last Designation:

Name of Organization / Department:

Total Length of Service / Experience:Number of years.. Details of Service / Experience:

Years - From To	Designation / Position	Department / Organisation

Number of ToT programs attended:Details of Training of trainers (TOT) attended: Conducted by Department of Personnel and Training / NIRD&PR/ SIRD&PR/ ETCs

Years	Name of the Program	Name of the Institution

Number of Training Programmes in which you acted as Resource Person:Details of Training Programmes

Years	Place of Training	Subjects / Themes	Target Audience	Number of programmes

Number of TNAs conducted:Details of TNAs conducted:

Years	Name of the organization	Target Audience	Number of assessments

Number of Training modules Prepared:Details of Training modules Prepared

Years	Subject /Themes	Target Audience

Preferred locations for training assignments:

Pan India	Preferred States

Availability of number of days in a month for training assignments:

Month	Days of availability

Indicate interested thematic areas:(You can choose more than one)
Democracy and Governance
Financial Management
Panchayat Management
E-Governance
Participatory Planning
Leadership Development & Management
Sectoral Schemes - Economic
Sectoral Schemes – Social
Gender and Governance
Inclusion and Empowerment
Governance in 5th Schedule Areas
Governance in 6th Schedule Areas

Write in your own words, three reasons, why you would liked to be empanelled as Resource Person, for training PRI functionaries

Δ