I wish to apply for enrollment for Diploma Course Training in: Please Check Appropriate Box:
Orthopaedic Sports Therapy Diploma Level 1/2Diploma in Spinal Manipulative Therapy (Y3 CP) Osteopathic DegreeDry Needling Course
Cranial TherapyThe Roll of Strapping & Taping
Name:
Date of birth:
Address:
City:
County:
Email: Work Phone:
Home Phone:
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Present Occupation:
Have you any training in the medical field or worked in related areas i.e. Massage, Sports Therapy or Holistic Medicine?
Do you have any physical disability or learning difficulties that may require special attention or adaptation while attending the college?
Do you have any other medical conditions of which the college should be made aware of?
Why have you chosen The Irish College of Osteopathic Medicine?
Has the course been recommended to you by a former student or other person? If so, the name(s) would be of interest.
Please feel free to give any other information you consider may be of interest to your application.
On receiving your application form a member of the ICOM team will be in contact with you shortly.
