DieTrac Technical Institute
Application for Admission
Send Application via:
Email: studentservices@dietrac.com
Fax: 1-709-535-6101
Letter Mail: DieTrac Technical Institute, 82 Premier Drive, P.O. Box 970, Lewisporte, NL, A0G 3A0
SOCIAL INSURANCE NUMBER
*
SELECT YOUR PROGRAM
APPLYING FOR:
SEPTEMBER
JANUARY
CARPENTER
CONSTRUCTION/INDUSTRIAL ELECTRICIAN
HEAVY DUTY EQUIPMENT TECHNICIAN
POWER LINE TECHNICIAN
STEAMFITTER/ PIPEFITTER
WELDER
STUDENT'S NAME
SURNAME:
*
GIVEN NAME:
*
INITIAL
BIRTH DATE
YEAR :
*
Month :
*
Date :
*
PRESENT ADDRESS
MAILING ADDRESS:
TELEPHONE NUMBER:
TOWN:
PROVINCE:
POSTAL CODE:
EMAIL ADDRESS:
PERMANENT ADDRESS (IF DIFFERENT FROM ABOVE)
MAILING ADDRESS:
TELEPHONE NUMBER:
TOWN:
PROVINCE:
POSTAL CODE:
EDUCATIONAL DATA *PLEASE PROVIDE A COPY OF HIGHSCHOOL TRANSCRIPT OR EQUIVALENT WITH APPLICATION*
HIGH SCHOOL LAST ATTENDED:
GRADE LAST COMPLETED:
YEAR COMPLETED:
POST SECONDARY SCHOOL ATTENDED, IF ANY:
POST SECONDARY TRAINING:
INDICATE FUNDING SOURCE (PLEASE CHECK ONE OR MORE SOURCES IF NECESSARY)
PAY YOUR OWN
STUDENT LOAN
AES (Advanced Education & Skills)
OTHER (PLEASE SPECIFY)