Programme Application Form Name *FirstLastAddress *Date of Birth *Phone No. *Email Address *EmailConfirm EmailSelect Module(s) *Care Support 5N0758Communications 5N0690Safety & Health at Work 5N1794Infection Prevention and Control 5N3734Work Experience 5N1356Care of the Older Person 5N2706Palliative Care Support 5N3769Person Centred Focus to Disability 5N1728Care Skills 5N2770Intellectual Disability Studies 5N1652Manual Handling and Safe Patient MovementDefibrillator TrainingLevel of experience in this area(s) *Tell us about your previous learning *Course Title | Result Achieved | YearHave you achieved any other training or skills which have been of benefit/interest to you? *What do you hope to learn from this programme(s)? *Please let us know if you need any assistance to successfully complete the programme e.g. reading, writing, computer literacy skills or any other special needs *Are you a medical card holder or in receipt of social welfare? *YesNoIf yes, you are exempt from certification fees. Please furnish copy medical card or copy social welfare receipt as proof of exemption. Data Protection *I have read, understand and consentUnder the Data Protection Act 1998 and the Data (Amendment) Act 2003 and GDPR May 2018, personal information and assessment material recorded manually and electronically will be stored safely and treated as confidential by RSG Flexible Learning College. Such data will be processed fairly for specified purposes and on the basis of the consent of the person concerned or some other legitimate basis laid down by law. Full Privacy Policy visit: www.rsg.ie/privacy All learner information given on this form will be kept confidential and will only be shared for the purposes of authentication, certification and monitoring. EmailSubmit FacebookTwitterLinkedinPinterestemailPrint
