1) Surname*:2) First Name(s)*:3) Full Name as stated on birth certificate*:4) Title:Ms Mr Mrs 5) Gender*:Male Female 6) Date of Birth*:Format DD/MM/YYYY7) Country of Birth*:8) Nationality*:9) Have you previously studied at NUI Galway?Yes No If you selected "yes" please specify what year you were registered:10) Address for Correspondence:Please ensure you are contactable at this address at all timesAddress 1Address 2Address 3Address 4County:11) Telephone (Mobile)*:FORMAT 086600101212) Telephone (daytime):13) 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)14) PPS Number*:15) Particular student needs:Access (wheelchair etc.) Learning Supports (Dyslexia etc.) Other (please specify) If you selected "other" please specify:16) Second Level / Leaving Certificate or final examinationsFinal Exam taken:Examination dates:Subjects taken:Level:Grades achieved:17) Qualifications (Applicants may be requested to forward syllabus and other details of undergraduate courses followed):Name of Institution 1 attended:Years of Study from - toProgramme title:Award result:Name of Institution 2 attended:Years of Study from - toProgramme title:Award result:Name of Institution 3 attended:Years of Study from - toProgramme title:Award result:18) 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 Held
Fiona Dwyer Programme AdministratorCPD Certificate in Biodiversity & Conservation ManagementAdult and Continuing EducationGalwayDelaying 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.