Application Form

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)