CSI M&E Staff Profile (PDF)

Monitoring and Evaluation of the Civil Society Intervention (CSI) Program
Pemantauan dan Penilaian Program Civil Society Intervention (CSI)

CIVIL SOCIETY INTERVENTION (CSI) STAFF PROFILE

CSI Branch/Location
CSI School
Position in CSI

Facilitator / Coach / Counsellor / Para Counsellor

Name
IC Number
Gender

Male / Female

Address

Telephone Number

Mobile:
Home:

Occupation
Email
Highest Education Level

Primary School / Secondary School / University

Do you have experience working with children/youth?

YES / NO

Do you have experience working with at-risk children/youths?

YES / NO

Do you feel committed to work with at-risk children/youths?

YES / NO

How long have you been in your position (facilitator/coach/counsellor) in the
CSI program? (indicate whether in months or years)

_____________

FOR COUNSELLORS AND PARA COUNSELLORS ONLY:
YES / NO
Do you have counseling experience?

Monitoring and Evaluation of the Civil Society Intervention (CSI) Program
Pemantauan dan Penilaian Program Civil Society Intervention (CSI)

Education/Training Background
Please list any formal education you have had, any qualifications you may have obtained or any
other kind of training or learning activities you may have completed that are relevant to this
position.
Duration
Name of
(in months/
College/Organisation
years)

Course/Program

Qualification (if
applicable)

Employment and/or Voluntary Experience
Please list any employment experience you have, starting with the most recent. Please also
include any other voluntary work you may have done.
Name of Employer
or Voluntary
Organisation

Duration
(in months/
years)

Position

Main Duties

Monitoring and Evaluation of the Civil Society Intervention (CSI) Program
Pemantauan dan Penilaian Program Civil Society Intervention (CSI)

What kind of training/workshops would you suggest EWRF conduct to help you carry out your
duties in the CSI program effectively?
______________________________________________________________________________