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 1Address 2Address 3Address 4Address 5:10) 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) Particular Student Needs:Access (Wheelchair etc) Learning Supports (Dyslexia etc) Other (please specify) If you selected "other", please specify:13) College currently being attended:14) Major/Level of current studies:15) G.P.A.:16) Area/Topics of Special Interest:17) Specifiy your choice of course*: You may select 1 course only.SU201 Beginners Course SU202 Elementary Course SU301 Intermediate Course SU302 Ardchúrsa 18) Specifiy your accommodation preference*:None required Family Guesthouse - Full board, Sharing Family Guesthouse - Full board, Single Occupancy 19) Please note any dietary requirements:20) Additional Information:
Fiona DwyerIrish Language 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.