QQI LEVEL 5 IN COMMUNITY ADDICTION STUDIES: APPLICATION FORM: 2018
Christina Murray-McEleney
Coordinator
Alcohol & other Drugs
Education & Training
North West Region
T: 0749161508
M:0879369312
E: christinamceleney@donegaletb.ie

You have made an application to participate in the QQI Level 5 Community Addictions course in September; in order to communicate with you about the course you have registered for, we will need your email address and telephone or mobile number. In order for me to retain and process your data , please tend to the question below. If you do not provide consent for your data to be retained and processed in respect of your application ALL of your personal data will be deleted from the system and you will not be contacted by me.
At the bottom of the form you can decide whether or not you wish to receive any further information about future education & training opportunities.

Email address *
*
Required
Name *
Your answer
OCCUPATION : (This question is optional, the purpose of the question is to gain an insight into the range of disciplines that participate in Alcohol & other Drugs Training & Education and to ensure the training content has relevance to the varied disciplines).
Your answer
Your PPS number: YOUR PPSN IS REQUIRED IN ORDER TO MEET QUALITY ASSSURANCE REQUIREMENTS OF QQI & ISSUE CERTIFICATION *
Your answer
Telephone / Mobile : Your contact number is required to enable communication to you about the course you have registered/ applied for. *
Your answer
Occupation : This question is optional; it allows the provider to gain insight into the range of disciplines that are interested in Alcohol & other Eduction and also to ensure the relevance of the training to the varied disciplines
Your answer
Please provide information on your qualifications and/or experience which you feel is relevant to participation on this course *
Your answer
What do you hope to learn from this course?
Your answer
CONSENT *
Required
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