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Day Course Application Form

COURSE APPLIED FOR:

Course 1:

Course 2:

Course 3:


 

PERSONAL DETAILS

First Name

Surname

Home Address

Email

Confirm Email

Country of Birth

Nationality

Date of Birth

Gender MaleFemale

PPS Number (must be supplied)

Mobile Number

Land Line

Address while attending College (if different from above)

Mother's Maiden Name

First Name

Surname


 

NEXT OF KIN DETAILS:

First Name

Surname

Contact Number

Do you have a medical card? YesNo

Card Number

Expiry Date

Do you have any medical conditions the College should be aware of? YesNo

Do you have a specific learning disability? YesNo


 

EDUCATIONAL DETAILS

What year did you leave school/college?

Name of school/college last attended

Address of school/college

What is your highest educational qualification?

What year did you receive that qualification?

If you have attended CityNorth College before, please state course name and years attended

Course Name:

Years Attended:


 

EMPLOYMENT STATUS

Before applying to this college, were you: EmployedUnemployedStudent

If employed, what was your occupation?

If unemployed, how long for? years: months:


 

SOCIAL WELFARE STATUS

Are you receiving a Social Welfare payment? YesNo

If yes, which one:

Where did you hear about us?


 

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General Admissions Information

  • All courses are interview based.
  • The College will post you an interview date for your chosen course.
  • If you do not hear from the College by the 7th August 2017 please contact the office on
    0214391782 or 0214397740 or Email info@citynorthcollege.ie
  • Note for International Students: if English is not your first language you must complete a compulsory English Language Assessment. The College will assign you the date of your Language Assessment. Please refer to the college website www.citynorthcollege.ie under the link International Students 2017 to read the requirements and exemptions for International Applicants.

Data Protection Note
Personal Data on this Form

The Cork ETB is registered as a Data Controller under the Data Protection Acts 1988 and 2003. The personal data supplied on this application form is required for the purposes of student enrolment, registration, administration, child welfare and to fulfil our other legal obligations. Contact details will also be used to notify you of college/Cork ETB events or activities. While the information provided will generally be treated as confidential to the Cork ETB, from time to time it may be necessary for us to exchange personal data on a confidential basis with other bodies including the Department of Education & Skills, the Department of Social Protection, An Garda SÌoch·na, the Health Service Executive, the National Educational Welfare Board or with another school/college (where the student is transferring). We rely on students and parents/guardians where a student is under the age of 18, to provide us with accurate and complete information and to update us in relation to any change in the information provided. Should you wish to update or access your/your child's personal data you should write to the college Principal.

By submitting this form you are indicating that you accept that your data may be used for the purposes above.
Data Protection Policy of the Cork ETB
A copy of the full Data Protection Policy of the Cork ETB is available at www.cork.etb.ie or on request from The CEO, Cork ETB, 21 Lavitt's Quay, Cork.