APPLICATION FOR
INDIA MUSIC THERAPY
POST GRADUATE TRAINING PROGRAMME



GENERAL DETAILS

 


 Surname:                       ……………………………………………………… Mr.    ………Mrs. …………Miss ………Dr.……………

Forenames:                     …………………………………………………………………………………………………………

 

Home Address       : ……………………………………………………………………………………………………………….

 

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Tel : ……………………………..  Mob : …………………………..    Email: ………………………………………………

 

Business Address : ……………………………………………………………………………………………………………….

 

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Tel : …………………………….. Mob : …………………………..    Email: ………………………………………………

 

 

RELEVANT QUALIFICATIONS (POST SCHOOL QUALIFICATIONS & COURSES ATTENDED)

 

Full Title

Institution/Awarding
Body

Dates

From:
To:

Full-Time
Part_Time

Teachers Only

Please indicate if qualification gives DIEE
recognised qualified teacher status.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please continue on a separate sheet if needed.

 

RELEVANT WORK EXPERIENCE

 

Name of Organistion

Position

Dates

From:
To:

Full-Time
Part_Time

Main Areas of Responsibility

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please continue on a separate sheet if needed.

 

If currently employed in Education, please state type of School/College:

 

 

 

 

 

 

 

Please give name, address, telephone number & position held of one further referee. (Please state if you
do not wish a reference to be sought from your present employee in the first instance and give alternative
referee.

 

 

 

 

 

 

 

 

 

Please give reasons why you have applied for this programme

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This space should be used to provide any further information which you think is relevant to your application.

 

 

 

DECLARATION

 

I confirm that the above statements and particulars are true. 

 

Signed          :  ………………………………………………          Date       : …………………………………………………..

 

 

Print Name   :  ………………………………………………          Position : …………………………………………………..

 

 

 

 

Otaker Kraus Music Trust
2, Twinning Avenue, Twickenham
Middlesex TW2 5LL UK

 

Tel. 020 8894 2007 • Fax 020 8898 5084• E-mail: info@okmtrust.co.uk