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Your Details:




   
Current Employment:

Please indicate whether Operational Manager, Ward Sister, Educator or other (100 characters max)




   
Patient Category:
(This is to be completed only if you are working in clinical area):
   

I would like more information about:
UCT Registered, Fully Online courses:
Other HCCNDU Courses / Activities

By providing the information requested you will be agreeing that your personal information (including the personal information contained on this enrolment form and your training activity data) may be used or disclosed by the HCCNDU for statistical, reporting, regulatory and research purposes. The HCCNDU in collaboration with, and under the auspices of, the University of Cape Town’s data and privacy policy, may disclose your personal information for these purposes to third parties, including:
  • HCCNDU donors/funders – even if you are enrolled in the programme funded by a donor or not;
  • Government departments and authorised agencies;
  • Researchers involved in monitoring and evaluation of the HCCNDU.
Should you have questions or concerns about this, you are welcome to contact the Program Manager Jane Vos (HCCNDU, Faculty of Paediatrics and Child Health, University of Cape Town) by email at: jane.vos@uct.ac.za with any questions about the use of this data or your part in it. 
The collection of this data has been subject to review and approval by the HREC (Human Research Ethics Committee) of the University of Cape Town. If you have any questions or concerns about the study, please contact the HREC (Human Research Ethics Committee) by email at: shuretta.thomas@uct.ac.za

 Thank you so much for taking the time to complete this form.
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