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)