UCD Innovation Academy Postgraduate / PhD Elective Modules Registration Form  
***PLEASE READ: Please note that this form is just an expression of interest. By completing it, you are NOT registering to the module.***
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First Name *
Last Name *
Student Number
UCD Email Address *
Phone Number
Discipline *
School
Supervisor's Name (PhD only)
Co-Supervisor's Name (PhD only - if applicable)
Have you consulted with your supervisor / school about taking this module?
Which module (s) would you like to register your interest for? *
Required
How did you hear about the Innovation Academy *
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