1) Please select the course you wish to apply for:Foundation Diploma - Training and Education Foundation Diploma - Skills for Life and Employment 2) Have you previously studied at NUI Galway?Yes No If you selected "yes" please specify what year you were registered:3) Surname*:4) First Name(s)*:5) Full Name as stated on birth certificate*:6) Gender*:Male Female 7) Date of Birth*:Format DD/MM/YYYY8) PPS Number*:9) Nationality*:10) 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)11) Home Address:Address 1Address 2Address 3Address 4County:12) Address for Correspondence:Address 1Address 2Address 3Address 4County:13) Telephone (Work):14) Telephone (Home):15) Telephone (Mobile)*:FORMAT 086600101216) How did the course come to your attention:17) Particular student needs:Access (wheelchair etc.) Learning Supports (Dyslexia etc.) Other (please specify) If you selected "other" please specify:18) Payment of fees (please tick):If your employer is funding your participation on this course, please enclose a completed Sponsorship Letter with your application.Personal Funds Sponsorship by employer Other (please specify) If you selected "other" please specify:19) Please provide below details of your Employment History (commencing with the most recent):Name of Employer 1:Address Position HeldName of Employer 2:AddressPosition HeldName of Employer 3:Address Position Held20) Give a brief statement of your reasons for applying for this course:21) Outline how this course would be of benefit to you in your employment:22) Number of years in training role23) Description of training experience:Organisation and job title 1:Training experience 1From - toOther relevant detailsOrganisation and job title 2:Training experience 2From - toOther relevant detailsOrganisation and job title 3:Training experience 3From - toOther relevant details24) Training and Knowledge in computers:25) Qualifications (Applicants may be requested to forward syllabus and other details of undergraduate courses followed):Name of Institution 1 attended:Years of Study from - toMajor areas of specialisation:Qualification:Class of Qualification (e.g. 1st Class Hons.)Name of Institution 2 attended:Years of Study from - toMajor areas of specialisation:Qualification:Class of Qualification (e.g. 1st Class Hons.)Name of Institution 3 attended:Years of Study from - toMajor areas of specialisation:Qualification:Class of Qualification (e.g. 1st Class Hons.)26) Leaving Certificate or final examinationsFinal Exam taken:Examination dates:Subjects taken:Level:Grades achieved:27) Name and Address of two independent refereesName of Referee 1AddressTelephone NumberName of Referee 2AddressTelephone Number
AdministratorFoundation Diploma in Training and EducationOpen Learning Centre Ballard HouseWestsideGalwayor e-mailed to email@example.com Delaying sending in these documents means your application cannot be processed.Please check that you have answered all questions. When completed, please press "submit" to send your application, you will then be sent an acknowledgment, so you will know it was successfully submitted. Best of luck with your application.