| 1. Name : | Mr./Ms. | First/ | Last/ | Middle |
|---|---|---|---|---|
| 2. Training Course | ( ) Leader | ( ) Rehabilitation | Year attended | |
| 3. Home Address | ||||
| Country | ||||
| Tel | Fax | |||
| Mobile Phone | ||||
| 4. Date of Birth: Month | / Date | / Year | ||
| 5.Disability: | ( ) Physical | ( ) Visual | ( ) Hearing | ( ) Others |
| 6.Occupation at present | ||||
| Title | ||||
| Name of Organization | ||||
| Office address | ||||
| Tel | Fax | |||
| URL | ||||
| Responsibility | ( )Management | ( )Accounting | ( )Instructor | ( )Social Worker |
| ( )Clerical | ( )Teaching Staff | ( )Volunteer | ( )Others |
1. Have you contacted the JICA office in your country after the course? Reason you contacted if answer is “Yes”.
| ( )Regarding Project | ( )Collect Information | ( )Greeting | ( )Others (white_space) |
2. Do you remain in contact with any ex-participants? Reason you contacted if answer is “Yes”.
| ( )Regarding Project | ( )Collect Information | ( )Greeting | ( ) Others ( white_space) |
3. Have you utilized the knowledge obtained in the course in your activities/projects? If answer is Yes, please describe your activities/projects briefly.
| Name of Activity/Project | Period | Your Responsibility | How did you utilize it |
|---|---|---|---|
If answer is “No”, any reason you did not?
[Internet]
1. Types of information you require. ( )Global trends on disability issues ( )The latest technology information ( )New Japanese systems, and laws on disabilities ( )Prominent projects carried out by other ex-participants ( )Exchange information among ex-participants ( )Information on training/seminar opportunities ( )Funding support information ( )Information on JICA ( )Others( white_space ) 2. Internet Access
Do you access the Internet?
| ( )Yes (Please answer to A-E) | ( )No (Please answer to H-I) |
If your answer is Yes, answer the questions follow. A. What kind of Internet connection do you have?
| ( ) Dial-up | ( ) 24-hour access fromhome | ( ) LAN (local area network) at work |
| ( ) Internet Cafe | ( ) Others ( white_space ) |
B. What is the connectionspeed of the Internet access you have, if you know?
| ( ) less than 64 Kbps | ( ) less than 1 Mbps | ( ) less than 10 Mbps |
| ( ) less than 100 Mbps |
C. How often do you access the Internet?
| ( ) All the time | ( ) Once a day | ( ) 1 or 2 / week | ( ) 1 or 2 / month |
D. Where do you usually access the Internet?
| ( ) Office | ( ) Home | ( ) Office and Home | ( ) Internet Cafe | ( ) Others () |
E. How much do you pay for the Internet?
| ( ) Metered Charge (US dollars per minute) |
| ( ) Fixed Charge (US dollars per month) |
| ( ) Others ( white_space ) |
F. What do you usually access?
| ( ) Web | ( ) E-mail and Web |
If your answer is No, answer the questions follow. H. Do you plan to start using the Internet in near future? I. How do you want to receive information from us? Describe your needs and expectations for the follow-up program. Describe your future plans in the disability field if any. If you have contact with ex-participants, please let us know their addresses.
| 1. Name Mailing address or E-mail |
| 2. Name Mailing address or E-mail |
| 3. Name Mailing address or E-mail |
Please return this questionnaire to the address below not later than July 12th. Secretariat of JICA Follow-up Program for Leaders of Persons with Disabilities & Rehabilitation of Persons with Disabilities Courses Training Section, JSRPD 1-22-1Toyama, Shinjuku-ku, Tokyo 162-0052 Japan
FAX: +81(0)3-5273-1523Email : inquiry@dinf.ne.jp
Thank you for your cooperation!
