Expression Of Interest (EOI) form for OpenMed open education course Information about the EOI for the OpenMed Course * Fill in all required fields 1.Personal data *First name: *Family name: *Gender:MaleFemale *Date of birth (dd/mm/yyyy): *Nationality: *First language: *Institution: Faculty/Department *Country *Email *Direct / Mobile Phone Number (including international dialing code) 2.Profile 2.1Background and current position *Degree achieved: *Current position: *Your functions: *English language level (as a foreign language)BasicIndependentProficient *Please upload your CV or short bio (max 3 MB - .pdf, .doc, .docx) *Please upload your picture (max 3 MB - .pdf, .jpg) 2.2Main subject field *Broad field:---00 Generic programmes and qualifications02 Arts and humanities03 Social sciences, journalism and information04 Business, administration and law05 Natural sciences, mathematics and statistics06 Information and Communication Technologies (ICTs)07 Engineering, manufacturing and construction08 Agriculture, forestry, fisheries and veterinary09 Health and welfare10 Services Detailed field [i]: [i]: the ISCED-F 2013 search tool should be used to find the ISCED 2013 detailed field of education and training. 2.3Digital competences self-assessment Please refer to the European Digital competences Self-assesment gridhttps://europass.cedefop.europa.eu/sites/default/files/dc-en.pdf *Information processing:---Basic userIndependent userProficient user *Communication:---Basic userIndependent userProficient user *Content creation:---Basic userIndependent userProficient user *Safety:---Basic userIndependent userProficient user *Problem Solving:---Basic userIndependent userProficient user 2.4Experience with online learning *Experience with open and distance/online learning---YESNOLittle Experience *If yes, please briefly describe your experience, i.e. designing and delivering online learning for students, type of learning, platform used, etc. (max 500 characters) 2.5Awareness of the core concepts of Open Education self-assessment *Open Education---Very poorPoorAverageGoodVery Good *OER---Very poorPoorAverageGoodVery Good *OER production and use---Very poorPoorAverageGoodVery Good *MOOC---Very poorPoorAverageGoodVery Good *Open licensing---Very poorPoorAverageGoodVery Good *Open educational Practices / Open Pedagogy---Very poorPoorAvarageGoodVery Good 3.Willingness 3.1Why do you want to attend this Training Course?* 3.2Please elaborate on the aspect of the Training programme of particular interest to your teaching practice: 3.3Why do you think Open Education matters in your teaching practice and/or in your higher educational context? 3.4A successful learning group requires the support of all its members. How will you help your peers succeed in achieving their learning goals? 4.Commitment 4.1I will attend as a member of the learning circle facilitated by:*---Cairo University, EgyptAlexandria University, EgyptCadi Ayyad University, MoroccoUniversité Ibn Zohr, MoroccoBirzeit University, PalestineAn-Najah National University, PalestineGerman Jordanian University, JordanPrincess Sumaya University for Technology, JordanNotre Dame University-Louaize, LebanonCoventry University, UKI still do not know 4.2Please acknowledge your commitment to the following: I understand that I need to attend at least 70% of the online training modules* I commit to maintain contact with my local learning circle* I commit to contribute to a discussion forum as part of the actvities of the learning circle* I understand that I will be required to submit a project in Open Education by end of Match 2018* Authorization to process personal data I hereby authorize the treatment of my personal data.
