School of Nursing and Midwifery Professional Credit Award module application form

There are two steps in this Application Process:
1. Fill in the Online Application Form, see below.
2. Then post in the Relevant Supporting Documentation, see below.

1. Online Application:
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).

Surname*:

First Name(s)*:

Gender*:

Male

Female

Date of Birth*:

Format DD-MM-YYYY

Nationality*:

Non-EU

If Past Student of NUI Galway please enter previous Student ID Number:

Address*:

Address Line 1
Address Line 2
Address Line 3
Address Line 4

Mobile number *:

Landline number:

Email Address*:
(Please ensure you provide a valid email address as any further correspondence from NUI Galway will be emailed to the email address you provide)

Education and Training*:

Title of course/qualification (Course 1):
Institution attended:
Year completed:
Title of course/qualification (Course 2):
Institution attended:
Year completed:
Title of course/qualification (Course 3, if applicable):
Institution attended:
Year completed:
Title of course/qualification (Course 4, if applicable):
Institution attended:
Year completed:

Employment details*:

NMBI (An Bord Altranais) PIN:
Current job title:
Current employer:
When current employment commenced:
Brief employment history:

Personal Statement*:

Please outline briefly your reasons for applying for this course (maximum 500 words):

2. Supporting Documentation Required:
Please post the following documentation to support your application before the closing date to Mari Moran, School of Nursing & Midwifery, Aras Moyola, NUI Galway.

Copy of your passport photo page or birth certificate (if you have never been a student of NUI Galway).

Copy of original transcript of previous studies undertaken (if you have never been a student of NUI Galway).

A letter of support from your Director of Nursing/Assistant Director of Nursing.

Offers for places on Professional Credit Award modules are made within one month after the closing date. If your application has not been acknowledged by July 31^st/November 30^th 2013, please contact mari.moran@nuigalway.ie.

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.