Form A2A3

Technical Cooperation by The Government of Japan

Training Award of Japan International Cooperation Agency (JICA)
Application by the Government of
Sri Lanka Please provide one original
for a training course in the field of and four copies.
Please print or type
Sustainable Management of Irrigation Development Projects

(FOR JAPANSES OFFICIAL USE)

□Ordinary Group Course (集団コース) Course No.
□Special Group Course (一般特设) Course No.
Recent Photo
□Country-focused Group Course (国别特设)
□Counterpart (ヵウンターパート) 专门家名
プロジエクト名
□Ordinary Individual Course (个别一般)
□Others (C.S. 特别案件等)

PART A To be completed by the nominee.

1 FULL NAME (as in Passport, underline Family Name)
PERUMA BADUGE LAKSMAN PREMANATH
2 ADDRESS FOR CORRESPONDENCE 4 DATE OF BIRTH 5 AGE
Provincial Department of Agriculture Month Date Year
55 Yrs
North Central province,Anuradhapura,Sri Lanka
05 02 1955 07 Mth
Telephone: 025-2235364
3 NAME AND ADDRESS OF PERSON TO BE
6 SEX MALE FEMALE
NOTIFIED IN CASE OF EMERGENCY
Mrs.U.S.Premanath 7 MARITAL STATUS SINGLE MARRIED
Central Bank of Sri Lanka
Anuradhapura 8 NATIONALITY Sri Lankan
Sri Lanka
     
9 RELIGION Buddist
Relationship to you: Wife
Telephone: 025-2222047
10 EDUCATIONAL RECORD

Years Attended Qualification

Institution City/Country Subject
From To Obtained
University of Peradeniya Sri 1976 1980 B.Sc General
Peradeniya Lanka 1989 Jan. 1990 May (Agriculture) Agriculture
Tucson,U.S.A. M.Sc
University of             Agriculture

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 Arizona Education
           
11 TRAINING OR STUDY IN FORENGN COUNTRIES (in relation to professional interests.)
Period Certificate/
Institution City/Country Field of Study
From To Degree Awarded
Svalof Sweden            
Weiball Thailand Aug.30 Oct Training Sustainable Agriculture
Department       May 14 16,1998 Rice Processing
of Agriculture May Training
      25,2001

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12 EMPLOYMENT RECORD
1) Present Place of Employment
Name Title of present Job
Provincial Department of Agriculture Provincial Director of Agriculture
      Date of Taking Up Post
    1st May 2010
Address Type of Organization
North Central Province Office,
Anuradhapura Governmental/public
Sri Lanka. Private
Telephone: 86-025-2235364 International
Telex/Fax: 86-025-2222189 Others

2) Previous Job

Name and address of Organization Description of Your Previous Job

In Service Training Institute 1.Training of Trainers
Mahailuppallama 2.Training of Farmer Leaders
Sri lanka 3.Management of Training Staff, Field Staff and
      Resourcers who visited to the istitute.

Previous Title/Post and Dates(from/to) 4.

     
Assistant Director of Agriculture
     
2001 January to 2006 October
3) Describe briefly the work of your organization and the service it provides.

The provincial Department of Agriculture, into which I am attached, has the mandate to carryout
agricultural extension programmes and activities concerning planning and management based in the
North Central province, the largest agricultural area in the country.

     

     

4) Describe your own job.

I serve as the Provincial Director , Provincial Department of Agriculture to which the sole responsibility
to dissemination of agricultural technology among farmers of the province is vested. In this connection, a
series of appropriately planned extension programmes and for extension officers are conducted. Iam also
responsible for manage extension staff in the province.

     

     

     

     

5) Explain how the proposed training will be of benefit to you in the work you will be doing on your return.

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Since the proposed training is aimed at "Sustainable Management of Irrigation Development Projects"
the content of the course directly addresses the activities of my present job. This would enhance my
abilities on the subject and I would be able to plan and conduct the extension programmes appropriately.
Once the programmes are successfully carried out my institute could perform effective work within the
farming community increasing the Agricultural productivity of the country.

     

     

     

     

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13 LANGUAGE PROFICIENCY
English
Listening excellent good fair poor
Speaking excellent good fair poor
Writing/Reading excellent good fair poor

Mother Tongue Sinhaleese

Other Language Tamil

excellent good fair poor

14 NOMINEE’S DECLARATION To be signed by the nominee.

I certify that the statements made by me in this form are true and correct to the best of my knowledge.

If accepted for a training award, I agree:

a) not to bring any member of my family.

b) to carry out such instructions and abide by such conditions as may be stipulated by both the nominating
Government and the Japanese Government in respect of this course of training.
c) to follow the course of study or training, and abide by the rules of the institution or establishments with
which I undertake to study or train.
d) to refrain from engaging in political activities, or any form of employment for profit or gain.
e) to submit any progress report or evaluation questionnaires which may be prescribed.
f) to return to my home country at the end of my course of study or training.

I also fully understand that if granted a training award it may be subsequently withdrawn if I fail to make
adequate progress, or for other sufficient cause including physical conditions determined by the Government
of Japan.

Date: 23rd December 2010 Signature:

PART B To be completed by nominee’s Director or Head of Department.

OBSERVATIONS OF NOMINATING ORGANIZATION
1 Describe what work the nominee will be expected to do in his return.
Other than the present responsibilities the nominee on his return is expected to take more responsibility on
Sustainable Management of Irrigation Projects.

     

5
      

2 Explain how the proposed training will be of benefit to the work of your organization.
North Central province of Sri Lanka is one of the most highly potential areas in agricultural production.
Due to financial restriction and limitation of trained extension personalls are major problems for
development of agriculture. Taking this tacts into consideration training on extension planning and
management is one of vital areas and would be helpful to develop agriculture in the province.

     

     

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3 (For Non-Group Training only)
Describe:
1) Subject area of the training required.
     
     
     
     
     

2) Special subjects which are particularly important and should be included in the training program
(continue on an additional sheet if necessary).
     
     
     
     
     

3) Period of training required (from/to).

     

4) Notice required before nominee can be released from present post.

     

PART C To be completed and signed by a responsible government official.

OFFICIAL NOMINATION

I certify that:

I have examined the documents in this form and I am satisfied that they are authentic and relate to
the nominee.

I accordingly nominate this person on behalf of the

Government of People's Republic of China

Date:       Signature:      

Position:       Name:      

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Organization:      

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 MEDICAL HISTORY AND EXAMINATION FOR JICA TRAINING AWARD

MEDICAL HISTORY TO BE COMPLETED BY NOMINEE

1 NAME OF NOMINEE (last name, first name, middle name)

PREMANATH PERUMA BADUGE LAKSMAN
     
     

2 DATE OF BIRTH 3 NATIONALITY 4 SEX 5 ADDRESS FOR CONTACT

(mo/day/yr) male Provincial Department of
Sri Lankan female Agriculture,
05.02.1955 North Central province,
Anuradhapura
Sri lanka.
6 NAME OF TRAINING COURSE/SEMINAR

"Sustainable Management of Irrigation Development Projects"

7 LENGTH OF TRAINING COURSE/SEMINAR(weeks, months)

Two Weeks

8 IMPORTANT NOTICE
Before you complete the Medical History Questionnaire, you are hereby notified that:

A medical condition resulting from an undisclosed pre-existing condition may not be financially
compensated for by JICA and may result in termination of your training program.

I understand and accept the terms of this notice. Yes No

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 9 NOMINEE WILL CHECK “YES” OR “NO” AND EXPLAIN

YES NO EXPLANATION

a. Have you had any significant or serious illness or      

injury? (If hospitalized, give place & dates.)      
      X      
     

b. Have you had any operations or advice by a      

physician to have an operation? (Give place &      
      X dates.)      
     
     

c. Do you currently use any drugs for treatment of a      

medial condition? (Give name & dose.)      
      X      
     

d. Have you ever been a patient in a mental hospital      

or sanitarium or treated by a psychiatrist? (Give      
      X place & dates.)      
     
     

10 NOMINEE WILL INDICATE “YES” OR “NO” TO EACH ITEM

DO YOU NOW HAVE OR HAVE YOU EVER HAD THE CONDITIONS LISTED BELOW?
(Check each item, if yes, enclose the relevant condition with a circle.)

YES NO CONDITION

a.       X Asthma, emphysema, or other lung conditions

b.       X Tuberculosis or live with anyone who has tuberculosis
c.       X High blood pressure, heart disease
d.       X Stomach, liver (hepatitis), gall bladder disease
e.       X Kidney or bladder disease. Stone or blood in urine
f.       X Diabetes (sugar in the urine)
g.       X Depression, excess worry, attempted suicide, or other psychological symptoms
h.       X Acquired Immune Deficiency Syndrome (AIDS)
i.       X Tumor, abnormal growth, cyst, or cancer
j.       X Bleeding disorder, blood disease (sickle cell anemia)

I CERTIFY THAT I HAVE READ THE ABOVE INSTRUCTIONS AND ANSWERED ALL

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QUESTIONS TRULY AND COMPLETELY TO THE BEST OF MY KNOWLEDGE.

11 PRINTED NAME OF NOMINEE 12 DATE 13 SIGNATURE OF NOMINEE

P.B.LAKSMAN PREMANATH 23RD December 2010

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