DIT LTTC CPD Application Form

Please use this application form to apply for DIT LTTC CPD modules. Any queries, please contact Linda Boyd at: linda.boyd@dit.ie or 01-402-7875
Module you wish to apply for *
First name *
Your answer
Surname *
Your answer
Address in full *
Your answer
Contact telephone number *
Your answer
Email address *
Your answer
Date of Birth (dd/mm/yyyy format) *
MM
/
DD
/
YYYY
Gender *
Nationality *
Your answer
PPS No.(Letter Number format) *
This information is required for statistical returns by DIT to the Higher Education Authority.
Your answer
Your Subject area / Discipline *
Your answer
DIT College & School / Other
If 'Other' please specify
Your answer
DIT Staff Number (if applicable)
Your answer
Previous DIT Student Number (if applicable)
Your answer
State briefly why you wish to participate in this module
Your answer
Please give details of any other information that may be relevant to your application
Your answer
Disability - if you have a disability or significant health problem, please provide details.
Your answer
Higher Education - as the CPD modules are at postgraduate level 9, please provide details of your highest qualification (year, qualification and awarding body / institution) *
Your answer
Fees: If you are a current DIT staff member and eligible for a Fee Waiver, please indicate your position with the submission of the Fee Waiver Form if applicable. *
Declaration: I declare that the information given by me on this form is true and accurate, and if accepted, I agree to familiarise myself with, and be bounded by, the regulations of the Dublin Institute of Technology. Student regulations are available from the Registrations Office or http://www.dit.ie/studentservices/registration/rulesregulations/ *
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