1) Have you previously studied at NUI Galway?Yes No If you selected "yes" please specify what year you were registered:2) Surname*:3) First Name(s)*:4) Full Name as stated on birth certificate*:5) Gender*:Male Female 6) Date of Birth*:Format DD/MM/YYYY7) PPS Number*:8) Nationality*:9) 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)10) Address for Correspondence:Address 1Address 2Address 3Address 4County:11) Telephone (Work):12) Telephone (Home):13) Telephone (Mobile)*:FORMAT 086600101214) How did the M.A. course come to your attention:15) Particular student needs:Access (wheelchair etc.) Learning Supports (Dyslexia etc.) Other (please specify) If you selected "other" please specify:16) 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:17) Second Level EducationFinal Exam taken:Name and Address of School attended:Examination dates:Subjects taken:Level:Grades achieved:18) Third Level Education (including Adult Education Courses):Non Irish Graduates may be requested to forward to forward syllabus and duration 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.)19) Training and Knowledge in computers:20) Publications and Research Interests:21) 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 Held22) Name and Address of two independent refereesName of Referee 1AddressTelephone NumberName of Referee 2AddressTelephone Number
AdministratorM.A. in Adult Learning and DevelopmentOpen 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.