IPTAS : Registration Form

Personal Details

* Required fields

First Name:*		Privacy Policy We keep your details for our use only, to evaluate your application for enrolment. Accuracy of Information It is essential that your answers and contact details are true and accurate. Attachment Rules File can't be larger than 2MB. File names must not contain spaces or special characters (e.g. :"/{}[]') Images must be jpg. CV can be word documents, text files or pdf format.
Last Name:*
Gender:*
Date of Birth:*
Nationality:
Attach Your Photo: (optional)
Attach Your C.V.: (optional)

Once you have entered your details above, complete the sections below. Click on the titles below to expand the form by sections and enter your details. Click here to open all main sections now. Click here to close again.

Home Address & Contact

Address1:*		About Guide Questions To evaluate your application we need to get to know you. The Guide Questions show the kind of information we seek to best understand your interests and why you wish to study at the Institute. Tell us about yourself. Contact Your contact details must be accurate for us to be able to contact you.
Address2:
City + Postcode:*
County:*
Country:*
Telephone:*
Mobile:*
Fax:
Email:*

Next of Kin

Name:*		Who to contact in case of emergency
Telephone (Day):*
Telephone (Eve):*
Relationship:*

Education

Click on the section titles and complete the highest level achieved. (One section only )

Leaving Certificate

Year Completed
School
School Address:
Results
Subject	Level	Grade
Irish:
English:
Maths:
History:
Geography:
Biology:
Chemistry:
Physics:
Agricultural Science:
Home Economics:
French:
German:
Spanish:
Music:
Technical Drawing:
Accounting:
Applied Mathematics:
Art:
Business Organisation:
Construction:
If you did not sit your Leaving Cert, give details of your further education here:

Third Level

Course Title:
Subjects Covered:
Institution:
Did you complete the course?	Yes No
Year Completed:
Result:
Additional Information:

Degree

Course Title
Subjects Covered:
Institution
Did you complete the course?	Yes No
Year Completed
Result:
Additional Information:

Post Graduate

Course Title
Subjects Covered:
Institution
Did you complete the course?	Yes No
Year Completed
Result:
Additional Information:

Professional

Course Title
Subjects Covered:
Institution
Did you complete the course?	Yes No
Year Completed
Result:
Additional Information:

Education

A Third Level degree is not mandatory for acceptance at the Institute.

You will have to provide documentary evidence to support your qualifications before registration can be completed.

Employment

Current Employer:*		Your employment details are for our consideration only and are not shared with anyone. Guide Questions: Please give from and to dates, employer, position, and your responsibilities. example: Mar 1992-June95, XCompany, sales, in-shop customer sales If you prefer, attach a short CV above, in the Personal Details section
Your Position:*
Role/Responsiblilities:*
Time at this Employment:*
	If your current employment is less than 3 years, please complete the 'Previous Work History' below:
Previous Work History:

Personal Statement

NOTE: Applicants must be proficient in English

Guide Questions

Your personal statement tells us about you. We want to know a little of your own background and why you are interested in physical therapy in particular. What motivates you to learn more.? The following questions might help organise your thoughts:

· Are you starting out or changing careers?
· What kind work do you do?
· Where would you like to be in 5 years time?
· What changes are you looking for?
· How did you first hear of us?
· Have you had experience of a treatment? – Tell us.
· Do you have knowledge or experience of other therapies
· Where do you think you could apply your skills as a therapist?
· Are you a "people person"?

Please include any additional information that you think will help us assess if you would be likely to benefit from the course.