Together Academy Student Application Form 2021
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Thank you for your interest in our September Intake Together Academy Course!
To apply for our newest Together Academy cohort, please complete the below form. Places are limited on the course, so we may not be able to accommodate everyone who is interested in participating. Early application is recommended. If you have any queries related to the completion of this form, please contact info@togetheracademy.ie.

Please note this is a new innovative pilot programme. While our timetables and course structure may change throughout the year based on the needs of our students, our core vision and goals remain the same. We ask for your understanding as we learn with our Together Academy students the best way to move forward in realising their goals.

Successful applicants will be contacted by the Together Academy with further details. Thank you!
Personal Details
Full Name *
Date of Birth *
MM
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DD
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Gender *
Home Address *
Eircode *
Mobile Phone *
Email *
Do you have any mobility issues? Do you wear glasses or have a hearing impairment? *
If you answered yes to the above question, please specify any accommodations you require
Does the learner have any behavioural support needs (including self-injury behaviour, phobias, sensory needs or other behaviours) that may effect their well-being when accessing Together Academy Programming? *
If you answered yes to the above question, please specify any accommodations or recommended positive behaviour support
What strategies do you use to help you learn? *
Skills & Strengths
Can you tell us if you need assistance in the following areas? *
Yes
No
Moving around indoors
Finding way around a new building
Taking public transport
Toileting- self care
Paying for items
Road Safety & Personal Safety
Reading (accessible material)
Concentrating on my work
Working independently
Asking for help
Reading signs & labels
Following instructions
Climbing stairs
Moving around outdoors
Finding way around a familiar building
Dressing
Remembering to bring personal items
Writing (short sentences)
Getting along with other people
Expressing self to others
Working in a team
Managing stress
Managing unplanned changes in day
If you have additional comments on the 'Skills & Strengths' section, please include them below. *
Have you any questions about the course or Together Academy programming? *
Next of Kin Contact Details
Please enclose the contact details of a next of kin in of emergency below.
Next of Kin Name *
Mobile *
Email *
Declaration- Please tick the boxes below before submitting your application *
Yes
I have read and understood the information about this course.
I confirm that all the information I have provided is correct
Electronic Signature *
Submit
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