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Professional Credit Awards: Module Application Form, Discipline of General Practice

Please note that you cannot save and submit this form--it must be completed at one sitting. You should scroll down this page first to see all the questions. There is a 500-word personal statement required: you may prefer to type this in another application (e.g., Word) and then cut and paste in the data to the relevant space below. Thank you.

(Those marked with * must be answered).








Gender*:

Format DD-MM-YYYY

Nationality*:



Address*:







Employment details*:

Third-level and postgraduate education*:

Module Selection*:

Please tick your chosen module(s) below.








Please check that you have answered all questions. When completed, please press "submit" to send your application. You will then be sent to an acknowledgement page so you will know it was successfully submitted.

Offers for places on professional credit award modules are made at regular intervals throughout the year. If your application has not been acknowledged one month before your chosen module is due to begin, please contact pgmed@nuigalway.ie.


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