1) Application Type:If applying through Host Institution, please specify at "other"Independent Enrolment Other (please specify) If you selected "other", please specify:2) Last Name*:3) First Name(s)*:4) Title*:Mr Mrs Ms Miss Other (please specify)If you selected "other", please specify:5) Gender*:Male Female 6) Date of Birth*: (Format Day Month Year)Format DD/MM/YYYY7) Nationality:8) If a past Student of NUI Galway please enter previous Student ID Number or state year (s) of study:9) Correspondence Address*:Address Line 1Address Line 2Address Line 3Address Line 4State and Zip Code:Country:10) Telephone:11) Email Address*: (PLEASE ENSURE YOU PROVIDE A VALID EMAIL ADDRESS AS ANY FURTHER CORRESPONDENCE FROM NUI GALWAY PRIOR TO REGISTRATION WILL BE EMAILED TO THE EMAIL ADDRESS YOU PROVIDE)12) College currently being attended:13) Particular Student Needs:Access (Wheelchair etc.) Learning Supports (Dyslexia etc.) Other (please specify) If you selected "other", please specify:14) Major/Level of current studies:15) G.P.A.:16) Area/Topics of Special Interest:17) Specifiy your choice of modules*: You may select 2 modules only.NOTE: The following modules cannot be taken together SU401 and SU406; SU405 and SU407 or SU402 and SU408SU401 Representing Ireland - Literature and Film SU402 The Archaeological Heritage of Ireland SU403 Irish History SU404 Gaelic Culture and Literature SU405 Irish Society SU406 Negotiating Identity - Irish Traditional Music and Dance SU407 Introduction to Art in Ireland SU408 Creative Writing: Poetry and Fiction 18) Specifiy your accommodation preference*:None required Family Guesthouse - Sharing Family Guesthouse - Single Occupancy Student Residence 19) Additional Information:
Fiona DwyerIrish Studies Summer School Administrator Summer School OfficeNational University of Ireland, GalwayIRELANDDelaying sending in these documents means your application cannot be processed.The Balance of tuition/fees and accommodation payments must be finalised by May 31, 2013Check that you have answered all questions. When completed, please press "submit" to send your application, you are then directed to a Thank You page, which will confirm your application has been successfully submitted. Best of luck with your application.