CPD Postgraduate Diploma in Leading Digital Transformation and Innovation Autumn 2021 TRANSFORM Programme 2 - Level 9

APPLICATION FORM

Thank you for your interest in the CPD Diploma in Leading Digital Transformation and Innovation, an initiative of Technology Ireland Digital Skillnet in collaboration with TU Dublin and IDA. To be considered for the programme, please complete this application form in full.

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* First Name (note: the details you enter will be the name that appears on your Diploma Certificate)

First Name

Middle Name

Surname

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* Home Address

Address

Address 2

City

County

Eircode

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* Your Occupation

Job Title

Company Name

Company Address

City

County

Eircode

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* Your Contact Details

Office phone

Mobile

Email address

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* Gender

Female

Male

Other

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* Date of Birth

Date of Birth

Date

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* Nationality

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* Occupational category

Manager

Professional

Technical

Other (please specify)

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* Your highest level educational qualification (select only one)

Junior Certificate (NFQ Level 3)

Level 4 Certificate (NFQ Level 4)

Leaving Certificate (NFQ Level 5)

Advanced or Higher Certificate (NFQ Level 6)

Ordinary Bachelor Degree (NFQ Level 7)

Honours Bachelor Degree or Higher Diploma (NFQ Level 8)

Masters Degree or Post-Graduate Diploma (NFQ Level 9)

Doctoral Degree (NFQ Level 10)

Other (please specify)

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* Please outline what you would like to gain from the TRANSFORM programme

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* Where did you hear about the Transform programme?

online

social media

friend or colleague

website

information event

my company

Other (please specify)

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* Grant Funding and Programme Fees (please indicate your agreement with the application conditions and indicate who will be paying the programme fee)

I understand that the fees on the programme are 40% grant aided by the Technology Ireland Digital Skillnet

I understand that the programme fee of €1500 is payable in advance of the programme commencement and is non refundable unless cancelled 30 days in advance of programme orientation.

My employer is paying the programme fee

I am personally paying the programme fee

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* Personal Information Management (please indicate your agreement)

I understand that my information will be passed to Technological University Dublin for student registration purposes.

TU Dublin will request your PPS number directly from you via email, this is to complete your registration

I understand my information, with the exception of my PPS number, will be shared with TU Dublin and Digital Skillnet

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* Data Protection

The programme that you are applying for is part-funded by the Technology Ireland Digital Skillnet. This programme is formally recognized and accredited within the Irish Educational system.

Skillnet Ireland and Technology Ireland Digital Skillnet collect information relating to participants on training programmes partially or fully-funded by Skillnet Ireland from the National Training Fund through the Department of Education and Skills (DES). Skillnet Ireland is mandated by the DES to monitor and evaluate training programmes and to ensure that funds are being used appropriately.

This information is also required by Technological University Dublin to enable you to receive formal accreditation from the college, recognized under the National Framework of Qualifications in Ireland (NFQ).

Skillnet Ireland, Technology Ireland Software Skillnet and Technological University Dublin will comply with all applicable Data Protection Legislation in the processing of the information and personal data provided by you in this Form.

I agree that the information provided can be used for the purposes outlined

Thank you - We will review your application.