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APPLICATION FORM FOR THE DIPLOMA IN IRISH

	* Necessary Information
*Surname:
*First Name(s):
*Sex:	Female Male
*Date of Birth:
Are you/were you a student of NUI, Galway? If you are/were please enter your Student Registration Number below.
NUI, Galway Student Registration Number:
PPS Number:
*Nationality:
*Country of Birth:
Address for correspondance: (correspondance will be sent to this address - please ensure you can be contacted at this address)
Home Address: (if different from above)
Home Phone:
Mobile Phone:
E-mail:
Please click the appropriate circle:	NUI, Galway Staff Member NUI, Galway Student Other
Have you completed the Language Placement Test? If so please enter the approximate date of completion. If you have not yet attempted the Test, you will have an the opportunity to do so after completing this application form.
Date of Test Completion:
Please choose your desired Level of the Diploma in Irish:
Leaving Certificate Irish result (if applicable):	Grade: Level:
*Choose the Centre in which you would like to do the Diploma:
If you entered "Another External Centre" please give details here:
Although you are not obliged to do so, if you have a disability or specific learning difficulty you are encouraged to indicate this on the Application Form in order to avail of the appropriate support from the University. Please tick this box (if applicable):
Where did you hear about this Diploma?	Radio Newspaper Word Of Mouth Internet Other
If you clicked "Other", please elaborate here:
	The fee is €1035 per year (for the 2010-2011 session). €535 must be paid before the start of the Diploma. The remainder will be due before 12-11-2010. If you are a student of NUI, Galway, please contact Oifig an Dioplóma, Room 108, Áras na Gaeilge or call 091 495248 / 3061 with regard to student fees. If you are not a student of NUI, Galway, you will be required to send a birth certificate and a passport-sized photograph to Oifig an Dioplóma (contact details below) before 14-08-2010.

CONTACT DETAILS FOR THE DIPLOMA

Address:

Caitríona Leather ,
Oifig an Dioplóma sa Ghaeilge,
Acadamh na hOllscolaíochta Gaeilge,
Ollscoil na hÉireann, Gaillimh,
Gaillimh.

Phone:

00 353 91 495248

Email:

andioplomasaghaeilge

oegaillimh.ie

Acadamh na hOllscolaíochta Gaeilge, Ollscoil na hÉireann, Gaillimh T: + 353 (0)91 595101
Nuashonraíodh an leathanach seo 07 / 09 / 2010