Part-Time Courses 2017 Application Form

* Indicates a mandatory field which must be completed

Campus Location

Please select which Lifelong Learning Centre you would like to apply to *:

Carlow Campus Wexford Campus Wicklow Campus

Programme Details

1st 2nd 3rd 4th

Personal Details

Please Note: The name you enter will appear on any parchment to which you may be entitled to.

Male Female

Yes No

Yes No

If yes please state:

Qualifications

The following information requested is for admission and statistical purposes only and will be treated in the strictest confidence.

Secondary School Irish University Irish Institute of Technology Post leaving Cert College Other

Junior Certificate Leaving Certificate FETAC/NCVA Apprenticeship Ordinary Degree Honours Degree PLC Qualification Masters Other

If you are under 23 years of age you must attach a copy of any qualifications you may hold (Parchment of your Leaving Certificate, FETAC or NCVA courses or any Certificate or Degree qualifications you may have).

Yes No

Yes No

Please Note: that disclosure of a disability and/or specific learning will not adversely affect your application in any way.

Programme Fees

Please Note: Fees must be paid before commencement of course. Once your application has been processed you will be contacted by Lifelong Learning with regards to making a payment.

If an organisation is paying part or all fees a letter on headed paper from that organisation must be attached to this application form indicating the amount of funding they will provide.

Yes No

Please Note: Programmes run subject to sufficient numbers. If a programme does not run a full refund is offered.

 

Applicant Declaration

I declare that the information given by me in this application is true and accurate and that if accepted I agree to read and abide by the regulations of Institute of Technology Carlow.
I hereby agree that the Institute may use my photograph in publications of the Institute where they judge this to be the best interest of either myself or the Institute. I understand that the Institute of Technology Carlow will treat all information as confidential and will not disclose such information except as permitted by Law. Other information provided will be held on computer and will only be used for purposes registered under the Data Protection Act.

Yes