IEC/R Mentor Application Form

⬇ Download IEC/R Mentor Application Form

Personal Profile

1. Title
2. Name
3. Contact details:
   • Telephone
   • Email
4. Current Organisation and Position:
   • Organisation
   • Position
5. Relevent USAR Operational Experience in the last 8 years in the following fields:
   • Management
   • Logistics
   • Search
   • Rescue
   • Medical
6. Previous IEC/R experience (please specify)
7. International Experience:
   • Previous mentoring experience
   • INSARAG Training:
     • INSARAG Awareness Training: Yes or No, Date
     • UNDAC Introduction Course: Yes or No, Date
     • UC Training Course: Yes or No, Date
     • Earthquake Simulation Exercise: Yes or No, Date
     • INSARAG IEC/R Team Leader and Mentor Course: Yes or No, Date
   • INSARAG Meetings:
     • USAR Team Leaders Meetings: Yes or No, Date
     • INSARAG Regional Meetings: Yes or No, Date
     • INSARAG Steering Group: Yes or No, Date
     • INSARAG Working Groups: Yes or No, Date
     • After Action Meetings: Yes or No, Date
     • Other
   • INSARAG USAR Capacity Assessment Missions/Capacity Building Projects: Yes or No, Date, Country
   • USAR Deployments
     • Date
     • Event
     • Organisation
     • Position
8. Applicant information:
   • Name
   • Email
   • Phone
   • Applicant Signature

Kindly complete the form and send electronically to the INSARAG Secretariat, at insarag@un.org