Bachelor of Science Degree Orthopaedic & Manipulative Therapy Application Form

Bachelor of Science Orthopaedic & Manipulative Therapy

Application Form
Name*

First NameLast Name
Address*

Street Address

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Phone Number*
Please enter a valid phone number. By providing my phone number I consent to IN.C.O.T. contacting me by phone or message.
Email*
By providing my email address, I consent to IN.C.O.T. sending me electronic communications.
Date of birth*

MonthDayYear
PPS Number*
Take Photo: (A photo ID is required for our records)*
Nationality*
To which gender identity do you most identify?*

MaleFemaleTransgender MaleTransgender FemaleGender Varient/Non-ConformingNot ListedPrefer not to answer
Education to date
In the box below, please indicate the title of your courses, start and end dates and the name of the education provider.*
Do you require special assistance during this course. I*

YesNo
If yes, please list your special needs to ensure the college is best equiped to assist you.
Payment: (Year 1 and Year 2 applicants)
The yearly fee of €4500 may be paid in two installments.

PTSB Ballincollig

BIC: IPBSIE2D

IBAN: IE70IPBS99071530531083
Payment 1: €2250 must be paid prior to the start of semester 1.
Payment 2: €2250 must be paid prior to the start of semester 2.
Booking deposit

A deposit of €500 is required with your application. This will be deducted from your first semester's fees. Please tick the box below to indicate that you have paid the deposit using the bank details given above.
I have paid the booking deposit of €500.*

Yes
Declarations

Please read the following information and tick the consent box below.
- I consent to IN.C.O.T. contacting any pearson to obtain further information about my application or to verify the information I have provided and agree that any person who is so contacted may provide IN.C.O.T. with any information about me which that person holds.
- I confirm that the information I have provided in this application is correct and understand that fraudulently procuring acceptance for recognition of prior learning will result in my application being cancelled.
- I consent to IN.C.O.T. having access to my personal data as supplied by me and I understand that this information will not be shared in any public forum. I consent to my information being kept on IN.C.O.T. database for the purpose of my application and course of study only.
I agree to the terms above.*

Yes
Signature*
Date*

MonthDayYear
Should be Empty:

Bachelor of Science Orthopaedic & Manipulative Therapy

Education to date

Payment: (Year 1 and Year 2 applicants)

Payment 1: €2250 must be paid prior to the start of semester 1.

Payment 2: €2250 must be paid prior to the start of semester 2.

Booking deposit

Declarations