DISTANCE EDUCATION
ADDITIONAL INFORMATION REQUEST FORM FOR 2009 ENTRY GRADUATE CERTIFICATE IN ALCOHOL AND DRUG STUDIES GRADUATE DIPLOMA IN ALCOHOL AND DRUG STUDIES Discipline of Pharmacology, School of Medical Sciences, Faculty of Health Sciences
SECTION 1 – Personal Data
SATAC Ref No: Family Name: Title: (Mr, Ms, Dr) Gender: Other Names: Male Female
Graduate Certificate
or
Graduate Diploma
1. INTERESTS AND APTITUDES (compulsory section) Please attach a brief statement outlining your personal aim(s) in wishing to undertake the Postgraduate Coursework program in Alcohol and Drug Studies. 2. CURRICULUM VITAE (compulsory section) Please attach a brief curriculum vitae with this form. 3. HOW DID YOU FIND OUT ABOUT THIS PROGRAM?
Signed ……………………………………………………….. Date …………………………………… 4. CHECKLIST – check that you have included the following information • Curriculum Vitae • Brief statement outlining personal aim(s) • 2 passport size photographs PLEASE SUBMIT YOUR COMPLETED FORM WITH ATTACHMENTS AND 2 PASSPORT SIZE PHOTOGRAPHS TO: Alcohol and Drug Studies, Program Administrator Discipline of Pharmacology School of Medical Sciences Faculty of Health Sciences University of Adelaide, ADELAIDE SA 5005 BY FRIDAY 5 DECEMBER 2008 FOR 2009 INTAKE. FURTHER INFORMATION Email: gdmads@adelaide.edu.au Facsimile: (08) 8224 0685 Telephone: (08) 8303 5989 or (08) 8303 4804
Correct as at 21 July 2008
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