Entrepreneurs in Science Unit
Faculty of Science

Application for Entry into Diploma in Innovation Management Program 2008

Surname:	______________________		First names:	________________________________

Student No:	______________________ 	Email address: ______________________________     

Home Tel:  ________________	Mobile: _________________	Date of Birth: _______________ 

Home Address: ____________________________________________________________________

Degree Program _____________________________________		Code/s  ___________/_________

Intended disciplines for 2nd, 3rd and 4th year studies (e.g. Biotechnology, Biochemistry, Chemistry)

___________________        ___________________       ___________________	

																				    Please  delete
Would you be available for full time study: 
						for one week of January/February (Summer session X1)? 		Yes/No
						for one week of July (Winter session X2)?		Yes/No
						for one week of November (Summer session X1)? 	Yes/No

Do you work or intend to work part-time during your studies?  Yes/No	 

Would you have difficulties in attending lectures/tutorials held in a 17:00 - 19:00 timeslot? 	Yes/No

Do you feel you could cope with some extra tutorial/assignments during main sessions (S1/S2)?	Yes/No

Do you have Internet access at home?												Yes/No

Do you have an interest in the Stock Market?											           Yes/No

How did you find out about the Diploma?  _______________________________________________	
Please submit your completed application either to our office, Room G05, Biological Sciences Building, or return by fax on (02) 9385 1530.

For further details on the Diploma program please contact the Entrepreneurs in Science Unit by phone on (02) 9385 1214, by email at eis@unsw.edu.au or visit www.eis.unsw.edu.au.