East Cork Education Center Youghal, Application Form for Sept 2021                      
*Only for DAYTIME  F u r t h e r   E d u c a t i o n   C o u r s e s in Youghal

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Childcare is Not Running in East Cork  21/22, this form is for applications to Healthcare course only if you are applying for Childcare please apply to Cork College of Commerce, Mallow College or Kinsale College *
FIRST NAME *
SURNAME *
Date of Birth
MM
/
DD
/
YYYY
PPS Number *
ADDRESS *
EMAIL ADDRESS
Mobile Phone *
Landline
Are you an EU Citizen *
If you are NOT an EU Citizen, Do You have Stamp 4
Do you have any disability including a learning disability? *
If you do have a disability please give details. In the case of Learning disabilities please give date of last assessment. Please note we ask this question in the case that we should need to apply for additional funding/resources on behalf of a learner.
During the last academic year, were you *
Tick more than one if you wish
Required
Indicate Length of time since being employed *
Employed means here that the majority of your income in this time is not from social Welfare
Do you have a Medical Card *
If you have a Medical Card, What is the Number
Please note you may have to pay additional costs if you have a medical card and dont give the college the number at this time.      All numbers are checked by the Department of Education.
If you have a Medical Card, What is the expiry Date
Are you applying for Back To Education Allowance, BTEA *
We strongly advise you that if you are receiving Social Welfare you notify the Dept of Social Protection as if you are not allowed to attend a fulltime course the department database will identify this and your payments will be stopped while the situation is investigated.
Will you be applying for a Susi Grant *
IF You have any previous QQI(Fetac) qualifications which you wish to get recognised *
You need to bring these to office and get copied and verified that suitable
Required
Where Did You Hear About This Course *
Required
What do you hope to do after you finish course *
Required
I understand that All Learners are required to Be Garda Vetted ((The Form will be sent to you after you are registered on either Healthcare or Childcare Course) *
Required
Is there anything additional you would like to communicate to us at this time please do so here.
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