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[null,null,null,"Application Form (2022)"]
[]
["* All fields are required unless otherwise indicated"]
["Personal Information"]
[" Honorific (title)",null,"Mr.,Ms., PhD, Dr, Professor, etc.",null,null,null,null,null,"Double click to attach your face photograph \n(JPEG Format: 4x3cm)"]
[null,null,"Fill in Here"]
["Full Name",null,"First Name:","Fill in Here"]
[null,null,"Middle Name:","Fill in Here"]
[null,null,"Family Name:","Fill in Here"]
["Your Name on Certificate",null,"Please fill in the name you wish to appear on the course completion certificate."]
[null,null,"Fill in Here"]
[]
["Nickname \n(if any)",null,"Fill in in case you would like to be called by nickname during the training course"]
[null,null,"Fill in Here"]
["Gender",null,"(pull-down menu)"]
["Date of Birth",null,null,"(pull-down)","(pull-down)","(pull-down)"," Age","Fill in Here"]
["Nationality",null,"Fill in Here"]
[]
["Organisation"]
["Official Presentation",null,"(pull-down menu)"]
[]
[null,null,"If you selected 'others', please specify below"]
[null,null,"Fill in Here"]
["Job Title, and/or Present Position",null,"Fill in Here"]
[]
["Organisation ",null,"E.g. name of ministry, association, state or private company, NGO/NPO, university, or other entity you are currently affiliated with"]
[]
[null,null,"Fill in Here"]
[]
["Department",null,"Name of the department within your organisation to which you are affiliated"]
[null,null,"Fill in Here"]
["Division / Unit ",null,"Name of the division or unit within your department (where applicable)"]
[null,null,"Fill in Here"]
["Website (If any)",null,"Fill in Here"]
["Office Address",null,"Fill in Here",null,null,null,null,null," Postal Code"]
[null,null,null,null,null,null,null,null,"Fill in Here"]
[]
["Office Phone",null,"Fill in Here"]
["Postal Address",null,"Please fill in in case desired shipping address is different from your office address",null,null,null,null,null,"Postal Code"]
[null,null,"Fill in Here",null,null,null,null,null,"Fill in Here"]
[]
["Mobile Phone\n(for urgent messages)",null,"Please fill in your mobile number or other form of communication in case of urgency"]
[null,null,"Fill in Here"]
["Email Address",null,"Please fill in the email address that can be shared with other participants"]
[null,null,"Fill in Here"]
[]
[]
["Professional History"]
["Professional Experience",null,"How long have you been working in the field of cultural heritage?",null,null,null,"Fill in Here",null,null,"years"]
[]
["Academic Background",null,"What did you major in at the university?",null,null,null,"Fill in Here"]
[]
["Educational Background",null,"Name of School/ University",null,null,"Duration (from-to)",null,null,"Obtained Degree"]
[null,null,"Fill in Here",null,null,"Fill in Here",null,null,"Fill in Here"]
[]
[]
["Employment History",null,"Organisation",null,null,"Duration (from-to)",null,null,"Job Title"]
[null,null,"(e.g. Ministry of ****) ",null,null,"(e.g. from Feb.2015 to Mar. 2018 ) ",null,null,"(e.g. Architect)"]
[null,null,"Fill in Here",null,null,"Fill in Here",null,null,"Fill in Here"]
[]
[]
[]
["Relevant Work (multiple answers: pull-down menu)",null,"(pull-down menu)"]
[null,null,"(pull-down menu)"]
[null,null,"(pull-down menu)"]
[null,null,"(pull-down menu)"]
[null,null,"(pull-down menu)"]
[null,null,"(pull-down menu)"]
[null,null,"(pull-down menu)"]
[null,null,"If you selected 'others', please specify below"]
[null,null,"Others:","Fill in Here"]
["Outline of Current Job Responsibilities",null,"Describe your current responsibilities and professional activities"]
[null,null,"-","Fill in Here"]
[]
[null,null,"-"]
[]
[null,null,"-"]
[]
["Participation Experience in Relevant Training Courses (If any)",null,"Course Name/ Venue (country) / Host Institution",null,null,null,null,null,"Date "]
[null,null,"Including ICCROM, UNESCO, WHITRAP, JICA, etc. courses"]
[null,null,"Fill in Here",null,null,null,null,null,"Fill in Here"]
[]
[]
[]
[]
["English Certificate\n (If any)",null,"TOEFL/ IELTS/TOEIC/etc.        "]
[null,null,"Certificate name",null,"Fill in Here",null," Grade/points",null,"Fill in Here","Fill in Here"]
[null,null,"Certificate name",null,null,null," Grade/points"]
["English Proficiency",null,"If you don't have English Certificate, please fill in the followings from the pull-down menu"]
[null,null,"Listening",null,"Speaking",null,"Writing",null,"Reading"]
[null,null,"(pull-down menu)",null,"(pull-down menu)",null,"(pull-down menu)",null,"(pull-down menu)"]
[]
[]
[]
["Questionnaire"]
["How did you learn about this course?",null,"(pull-down menu)"]
[]
[null,null,"If you selected 'others', please specify below"]
[null,null,"Fill in Here"]
["Where will you connect to the internet during the training course?",null,null,null,"(pull-down menu)"]
[]
["Familiarity with Online Meeting on Zoom or other platforms",null,null,null,"(pull-down menu)"]
[]
[]
[]
["I hereby certify that the above statements are true and correct to the best of my knowledge and belief. I also declare that my health allows me to undertake the whole training programme. If I were accepted, I agree:"]
[]
[]
[" - that ACCU Nara will publish my reports as long as they are used for the programme purposes;"]
[" - to have a professional and responsible approach towards the conditions presented by the organisers."]
[]
[]
["Date: "]
[]
["NAME IN PRINT:                                                          "]
[]
[]
[]
["Signature:                                                                                                                  "]