APPLICATION FOR APPROVAL OF A CONTINUING PROFESSIONAL DEVELOPMENT (CPD) ACTIVITY Please complete the on-line application form and hand deliver or courier the following: One hard copy of all the training material, including PowerPoint presentations and handouts, which will be used for the event. A CD/DVD of all the training material, including PowerPoint presentations and handouts, which will be used for the event. [This is the archive copy] Proof of payment CV of trainer/s A copy of a blank evaluation form for obtaining feedback from participants for rating of the relevance, quality and effectiveness of the event. Proof of VAT registration of the training provider's organisation, or if not VAT registered, the following three documents: Tax clearance certificate Company registration document A reference letter from a client To: CESA, Balvenie Building, Kildrummy Office Park, c/o Witkoppen and Umhlanga Rd, Paulshof, Johannesburg BODY APPLYING FOR ACTIVITY APPROVAL IN TERMS OF ECSA CPD POLICY Name of Training Provider: Training Provider's Website: Responsible Person: Title: First Name: Surname: Designation: Postal Address: Postal Code: Province: Telephone number: Code: No: Cell No. : Code: No: Fax number: Code: No: E-mail address: Company Vat Registration Number: DETAILS OF ACTIVITY Course Name: (Name on Certificate) Name/s of Presenter/s: NB Presenter CVs must be emailed to email@example.com 1 2 3 Duration of Activity: (Hours / Days) HoursDays National Hours: Course Category: Colloquium Conference Congress E-learning Large Group Workshop Lecture Refresher Course Seminar Workshop Pitched at NQF Level: (if applicable) Piched at Category of Registration: (if applicable) Engineering Discipline: (if applicable) Engineering Sub-Discipline: (if applicable) Nature of Activity: Engineering Project Management Technical Legal Office Finance Computer Skills Interpersonal Skills General Management Description of Course: Instances: Single Multiple Is the activity promoting a product? NoYes If the activity is a conference or site visit, please enter the date (or starting date): Where else have you submitted a request to have this activity validated? MOTIVATION FOR ACTIVITY TO BE APPROVED: Evaluation forms for obtaining feedback from participants for rating of the relevance, quality and effectiveness of the activity, must be provided. I, on behalf of the Training Provider body as specified above, hereby certify that I am fully aware of the CESA policy on the selection and appointment of training providers and the statutory requirements of continuing professional development as described in the ECSA Policy Document and undertake to comply with the requirements of serving as an approved provider for this activity. I confirm that I have seen the prices and confirm that I want to go ahead with this application Please type the verification code, exactly as you see it above, into the box below.