Registration Form

REGISTRATION FORM — EXPRESS YOUR INTEREST

CONTACT INFORMATION

NOTE: Incomplete applications will NOT be reviewed. Please ensure that you have fully completed all the application.

DEMOGRAPHIC INFORMATION

Demographic information collected is to ensure diversity of participants in the training and for program reporting purposes only.
NO names are nor will be associated with any of the information reported.
TO SELECT MORE THAN ONE GROUP:

  • WINDOWS PC: Click holding SHIFT-key (⇧) or CONTROL-key (Ctrl)
  • MAC OS: Click holding SHIFT-key (⇧) or COMMAND-key (⌘)
  • MOBILE: Click the menu above (0 items) and check each group that applies
Enter a group to which you belong if OTHER is checked

AGENCY | HEALTH PROFESSIONAL ENDORSEMENT

PLDI welcomes any person living with HIV to apply for this leadership course. PLDI™ is a professional development opportunity – not a retreat. Throughout the course, participants are encouraged to see themselves as part of a larger community of people living with HIV, to value and appreciate the unique experiences that accompany anyone living with HIV, and to understand the history and evolution of the global and local responses to HIV.

COURSE EXPECTATIONS AND RECOMMENDATIONS:
The training takes place over the course of days – and these days are very structured and intensive. While there are scheduled breaks, the days are quite long and people attending the training are expected to be present and participating for the duration, It is recommended for people whose physical and mental health is at a place from which they can fully participate.

COURSE PARAMETERS & LIMITATIONS:
There are limitations to what this course is able to achieve. It is not designed to assist people living with HIV to come to terms with their diagnosis, nor is it a therapeutic intervention. It is designed for people living with HIV who have an interest in building their leadership and resilience capacities in the HIV sector and their personal lives. Ensuring that PLDI graduates are supported, prepared and able to go back into their communities to commit to social change and to challenge HIV stigma is an ambitious undertaking. It is our belief that it is the collective effort and the passion of people living with HIV who have driven many.

APPLICANTS MUST HAVE THEIR HIV STATUS CONFIRMED BY AN AGENCY STAFF OR HEALTH PROFESSIONAL.

CONSENT & CONFIRMATION

By submitting this form :

  • I certify that the above information are true and wish to submit this request for participation in PLDI Leadership Training.
  • I am thereby authorizing PLDI to contact the above individual to confirm my HIV status.