Outreach School Leavers Access Course Application 2016/17

NUI Galway School Leavers Access Course is now closed. Applications will be still accepted for Ballinasloe, Carraroe and St. Angela's College Sligo until 5 p.m. 31st August, 2016 Please complete form completely before submitting. You can only submit once. Please note you will be requested to send supporting documentation within 10 days of submitting this on-line form.Please either photograph or scan all supporting documentation to your email and send as follows: To: access@nuigalway.ie Subject Line: School Leavers Access Course Docs In the body of your email add your name and list the documents that you have attached. References are required. Documents Required for Email Attachment: Passport/Drivers License Passport size photo A copy of Birth Certificate P21 from financial year 2015 where applicable Medical Card-photo of card Disability Evidence Evidence of Refugee status (where applicable) If English is not your first language, please provide evidence of your fluency to the required IELTS standard Please attach a copy of your Department of Social protection Statement 2015 Please attach a copy of your highest educational qualification (Leaving certificate, Fetac, Gcse, etc…) to date here Please attach a copy of your Notice of Assessment 2015 where applicable Reference forms can be downloaded at www.nuigalway.ie/access and emailed to your referee. They can then email back to the Access Office,accessoffice16@gmail.com Best of Luck in your application The Access Centre Paper applications are not encouraged due to the high volume of applications. If you are having difficulties attaching documents please come to the Access Office with them and we will scan for you.

1) Your Information*
First Name/Surname:

2) Personal Details*

3) Are you an EU National? Please tick the relevant fox from list below:

Format: YYYY-MM-DD

5) Is English your first language?


7) Do you have a Physical or Learning Disability? Please indicate yes or no


9) Did you grow up in a One-Parent Family? (up to the age of 17)

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