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: __________________________ Please return completed applications to the address below.
For Office Use Only: Eligible: Interview Offered: Interview Date: Letter of Interview Posted: Interview Attended: Tutor Signature: Date:
Yes No Yes No _____________________ _____________________ _____________________ _____________________ _____________________
The Nerve Centre 7-8 Magazine Street Derry BT48 6HJ