Application Details.

Application Form

Special Application Reference No. (Only used if applying under special circumstance given by DOCET, this reference number would be given to you by DOCET.)

Organiser Details

Organising Body:
Contact:
Address:
Post Code:
Telephone:
Email:
Title of Course:
Date of Course: (format of : yyyy-mm-dd)

Course Overhead Expenses to be met by DOCET

Payment to lecturers / tutors
(1) Fees £
(2) Travel and accommodation: £
Room hire for course: £
Advertising OR local mailshot costs: £
Hire of equipment: £
Payment to patients: £
TOTAL: £
Percentage of non-optometrists attending course: % (Please enter a number between 0 (zero) and 100)
TOTAL MINUS PERCENTAGE: £

Actual Overheads not met by DOCET

Administrative costs: £
Refreshments: £
Other costs: ( Please Specify )
£
TOTAL: £

Revenue Received

Total attendees:
Fee charged: £
TOTAL: £
Are you applying for funding from other sources? Yes No
If yes, how much? £