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Application Form
NATIONAL DENTAL NURSE TRAINING PROGRAMME OF IRELAND
Diploma in Orthodontic Therapy
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Application Form
PREFERRED TRAINING CENTRE
Which training centre do you wish to attend?
Please select...
Dublin
Galway
Distance Learning
PERSONAL INFORMATION
First name
Surname
Date of birth
Email address
Confirm email address
Telephone number (mobile)
Telephone number (home)
Photograph
Please upload a passport type photograph of yourself for your file. The photograph should be in jpg or jpeg format. Printed copies will not be accepted
Address 1
Address 2
Town
County
Post Code
EMPLOYER DETAILS
Name of current employer (first name and surname of supervising dentist)
Employer's Address 1
Employer's Address 2
Employer's Town
Employer's County
Employer's Post Code
Work telephone number
Employer's Email address
Confirm email address
Main duties
Date of commencement of employment with the above employer
Employment status
Full-Time
Part-Time
How many hours a week do you normally work?
You must work a minimum of 25 hours per week to be eligible to apply for the programme. Please note that should you work between 25 and 30 hours per week, it may take longer than 16 months to complete the programme. For further information, please contact the Nursing Administrator at
dentalnursetutor@dental.tcd.ie
Place of employment
Please select...
Health Service Executive
General dental practice
Specialist dental practice
Other
EDUCATION
Title of Secondary Level Education certificate received
Have you completed a Basic Life Support for the Healthcare Provider Course in Cardio-Pulmonary Resuscitation (CPR)?
Please select...
Yes
No
Date obtained
Do you have any special needs? (learning, medical or physical difficulties that we would need to be aware of)
Please select...
Yes
No
Please Specify
ADDITIONAL INFORMATION
Using this space, please tell us why you should be considered for a place on this programme
How did you hear about this programme?
Email
Practitioner
Previous graduate
Journal of the Irish Dental Association
Irish Dental Nurses Association
Other journal or magazine
Other
Please specify?
DECLARATION
I certify that the information provided in this application form is accurate and true to the best of my knowledge. I understand that providing incomplete or false information may result in my application not being processed.
Please select...
Yes
No
I understand that I must have access to a computer and internet access (high speed/broadband access is preferred) to enable daily access to the programme website.
Please select...
Yes
No
Please confirm by choosing yes, that you have read and understood the Application Process and Course Outline document. This is posted on the front page.
Please select...
Yes
No
Please confirm by choosing yes, that you have discussed this programme with your Dental Practitioner and have made him/her aware of time commitment needed.
Please select...
Yes
No
Please confirm by choosing yes, that you have daily access to a computer/laptop.
Please select...
Yes
No
Please confirm by choosing yes, that you have daily access to internet broadband.
Please select...
Yes
No
Please confirm by choosing yes, that you have good computer skills.
Please select...
Yes
No
Please confirm by choosing yes, that you know how to use the internet.
Please select...
Yes
No
Tick each box to confirm that you understand your application is not complete, and WILL NOT BE REVIEWED, until a copy of each of the below are supplied to the Dublin Dental University Hospital. Please ensure all parts of the Supporting Documentation are completed and submitted as listed below (this document is available on the NDNTP information page – see the 'Applications' area at the end of NDNTP page). Please scan and email all documents to
DentalNurseTutor@dental.tcd.ie
. PAPER APPLICATIONS WILL NOT BE ACCEPTED.
Payment of €35 non-refundable administration fee. Electronic Payments only. See Application Process document for the bank details needed. Send screenshot of proof of payment to
DentalNurseTutor@dental.tcd.ie
.Cash, card payments, cheques/bank drafts/postal orders are not accepted
Proof of non-infection with Hepatitis B. This must be dated be dated within 6 months.
Proof of non-infection with Hepatitis C. This must be dated be dated within 6 months.
Proof of Hepatitis B immunity. The result must be greater than 100 mIU/mL.
Signed practitioner declaration of support (this document is included in the supporting documentation package, available from the NDNTP information page on the website).
Completed verification of experience (this document is included in the supporting documentation package, available from the NDNTP information page on the website). This must be signed by each supervising dental practitioner for which you were employed.
Completed self-evaluation form and signed by the supervising dental practitioner (this document is included in the supporting documentation package, available from the NDNTP information page on the website).
Do not enter text
Undergraduate Programmes
Dental Science (B.Dent.Sc)
Dental Technology (B.Dent.Tech)
Dental Hygiene Diploma
Dental Nursing (Diploma)
Application Form
NATIONAL DENTAL NURSE TRAINING PROGRAMME OF IRELAND
Diploma in Orthodontic Therapy
Postgraduate Programmes
Library Services
International Students
Online Postgraduate Courses
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