Registration Form :
Please print this form, complete it, and post it to:
| Registration Form
Please complete in block capitals |
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| Title | Please attach passport photograph and enclose a second for use on your student card. |
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| First name(s) | |
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| Surname | |
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| Carmelite affiliation or community (if any) | |||
| Address | |
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| Post code | |||
| Country | |||
| Telephone number (including code) | |||
| E-mail address | |||
| Confirm E-mail address | |||
| Educational background (please give details) | |||
| Programme being applied for (please tick) |
Adult Education Diploma (Level 5) (_) Diploma (Level 6) (_) |
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| Do you intend to undertake the programme for assessment?
(please note that preference is given to students undertaking programmes for assessment; it is possible to change your mind either way once the programme has begun) Yes No |
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| From the list in the prospectus, please indicate the names of the modules you would first like to study in order of preference (1 being most preferred).
Please note, this is simply an indication; CIBI cannot guarantee the availability of requested modules at this time. If you have no preference, please leave this section blank. |
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| Please sign and date this form, and return it to the following address: CIBI, Gort Muire Carmelite Centre, Ballinteer, Dublin 16. Email: admin@cibi.ie. Phone: 00353-1-298-7706. Fax: 00353-1-298-7714. Do not send payment at this stage. CIBI will notify you shortly whether a place is available. By submitting this form you agree to be bound by the rules and regulations of the Carmelite Institute of Britain & Ireland. This form and the complete prospectus are available online at: www.cibi.ie | |||
| Signature: Date: |
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