Application for Full Time Courses

Creative Media Techniques Music Production Music Performance & Technology Video Techniques

(tick as applicable or state a preference if you are interested in more than one course)

APPLICANT DETAILS

Surname: Forename(s): Date of Birth:

Give the age that you will be on 1 September 2012:

National Insurance Number:

Home Address:

City: Postcode:

Day Tel No: Evening Tel No:

Email add: EMPLOYMENT STATUS Employed Employed Part Time Unemployed Economically Inactive QUALIFICATIONS What is the highest qualification (or equivalent) you hold? NVQ L1 NVQ L2 NVQ L3 NVQ L4 NVQ L5 GNVQ Please provide details of other qualifications you hold?

OTHER Why are you interested in doing this particular course? Date: ____________________________ Signed: __________________________ For Office Use Only: Eligible: Yes No Interview Offered: Yes No Interview Date: _____________________ Letter of Interview Posted: _____________________ Interview Attended: _____________________ Tutor Signature: _____________________ Date: _____________________

Please return completed applications to the address below.

The Nerve Centre 7-8 Magazine Street

Derry BT48 6HJ