FITA ICT Course Application Form
By filling in this form, I hereby declare that the information I have given above is true and correct. No information which could have a material bearing on my enrolment has been withheld. I understand that under the Data Protection Act, I have the right of access to personal information held by FITA about me and I also have the right to request FITA to correct any information which is inaccurate. I have an obligation to advise FITA if/when any of the personal information I have provided changes.
Name *
Your answer
Surname *
Your answer
Address *
Your answer
Village/Town *
Your answer
Post Code *
Your answer
Phone *
Your answer
Mobile *
Your answer
Email
Your answer
Date of Birth
MM
/
DD
/
YYYY
Identity Card No. *
Your answer
Special ID Card No. *
Your answer
Impairment Group *
Preferred venues, dates and times or other requirements pertinent to the course.
Your answer
Courses
Select one or more ICT courses or suggest new ones, which FITA can plan for.
*
• A FITA administration fee of EUR25 is applicable for each course/module applied for.
• Kindly note that applications can only be processed if accompanied by payment of the exact amount indicated above.
• Cheque payments must be made payable to FITA.
• A receipt issued by FITA must be presented on the first day of your course
Consent to use of data for processing of application *
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