HDCPsy & DCPsy intake form

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Step 1 of 7 - Program Preferences

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PERSONAL DETAILS
Select your Program
Intake wishes to enroll
Title (Mr/Ms/Dr/Rev.)
Surname/Family Name*
Name with initials*
Date of Birth
Gender
Citizenship
Country
NIC Number*
Permanent Address*
Address Address Line 2 City Country
Telephone
Fax
(Optional)
Mobile*
Email*
Enter Email Re-enter email

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GCE ORDINARY LEVEL (O/L) RESULTS
Year
Index Number
Results
Subject Grade

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GCE ADVANCED LEVEL (A/L) RESULTS
Year
Index Number
Results
Subject Grade

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Academic Qualification
English Language
University / Institute Qualification Year Class / Grade
Advanced by academic Institute
University / Institute Qualification Year Class / Grade
Professional Qualifications
Institute Year Award Status (Membership / Past Finalist etc.)
Vocational Qualifications
Qualification Institute Year Award NVQ Level

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EMPLOYMENT HISTORY
Details of the Present Employment
Company From To Designation Nature of Duties Number of years of experience
Employment History
Company From To Designation Nature of Duties Number of years of experience
SUPPORTING DOCUMENTS
Upload Supporting Documents
Drop files here or

Accepted file types: pdf.
- Attach any supporting documents
- File(s) should be in PDF format
- Maximum file size is 2MB per file
- Up to 10 files are can be uploaded

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PAYMENT DETAILS
Finance
Proposed Source/s of Finance (If it is not self-financing, Please provide the contact details of the financier)
Bank Receipt ( Application Fee )*
Accepted file types: jpg, gif, png, pdf.
- Attach a copy of the bank receipt
- Only jpg, gif, png and pdf file formats are allowed
- Maximum file size is 4 MB

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DECLARATION
I declare/affirm that the information provided by me in this application is true and accurate to the best of my knowledge and that in the event if they become untrue to whatever reason to indemnity the IHRA in any civil or criminal litigation and to be subjected to any decision taken on that regard by IHRA.
Name
03/04/2021
Untitled

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