Full Name:

Place of birth:

Date of birth: -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ------ January Febuary March April May June July August September October November December ---- 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Gender: ------ Male Female

Nationality:

Are you vision impaired?  

Yes
No

Level of vision:

low vision
blind

Education level : Select educationlevel less than high school high school some cologe diploma of the commercial college university level master medical degree PHD

Social status: Select socialstatus single separated divorced widowed married

Home phone:

Mobile phone:

Address:

E-mail address:

Have you ever joined an educational establishment or centre for people with a vision impairment?

Yes
No

Are you searching for a job?

Yes
No

Have you ever been employed?

Yes
No

If yes mention your job title.

Can you speak English?

Yes
No

Can you type using a computer keyboard?

Yes
No

Do you have previous experience in any of the following items?

Microsoft Windows.
Microsoft word
Excel
Access.
Internet explorer
E-Mail

Which kind of screen reader are you using?

Ibsar.
Hal.
Jaws.
Virgo.
Windows Eyes
If other, please specify.

Which of the following courses are you interested in?

IT training
Soft-skills training
English language training

What do you expect to be offered by Tamkeen?

How did you hear about Tamkeen ?

Tamkeen group Exhibitions News paper radio t.v. search engine friends link on other site E-mail from friend E-mail from Tamkeen Others