IDLTM Application Form - starting September 2024

Personal Details

Given Names *

Family Name *

Preferred Name

Date of Birth *

Gender *

MaleFemaleOther

Position *

TeacherAssistant/Director of StudiesAssistant/Academic ManagerPrincipalOther

Are you a native English speaker? *

YESNO

If NO, write your English language test score(s) here (e.g.IELTS, Pearson, TOEFL)

Contact Information

Email Address *

Work Phone

Home Phone

Mobile

Preferred Method of Contact: *

PostHome PhoneWork PhoneMobileEmail

Tertiary Education

Qualification *

Institution *

Year obtained *

Your current place of work

In which country and city are you currently working? *

Teaching or Management Experience

Organisation

Position

Dates employed (from...to...)

Professional Development

Please list any PD training you have completed, relevant to your application

Payment

Details of how and when to submit payment for the course will be sent separately.

*This is a test paypal gateway only - please enter your own payment gateway details in the payment field settings on the form builder

Student Declaration and Consent

Enter your name *

I declare that the information I have provided to the best of my knowledge is true and correct. I confirm that I have read and understood the information contained in the Student Information for this qualification. Access to your personal information recorded in this form and through any other means is restricted to UQ College administration and IDLTM trainers only. *

Signature *

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