Course Enrolment - Community Education KWETB

Course *

In case of applying for several courses, please list them in order of preference

Location *

Name *

Print name as you would like it to appear on your certificate.

Gender *

Address *

Eircode *

Date of Birth *

PPSN *

If the number cannot be provided, please contact us

Nationality *

Mobile number *

A mobile will allow us to text you any class changes.

Email *

Emergency Contact *

Are you a member of a community group? If yes, please name the group

Have you participated in an online course before? *

What device can you use to participate in an online course? *

How experiences are you using that device? *

The online class will be facilitated through the Zoom application. Do you need some support for using Zoom? *

Economic Status and Social Welfare Details *

If other, please specify

In receipt of social welfare payment. *

If yes, what is the payment?

How long have you been in your current category?

Education and Training History. What is your highest education level? *

Name of Course *

Year finished *

Country (if outside Ireland)

Is there anything else you wish to let us know?

Please include relevant medical information.

Yes! I would like to receive information about learning opportunities from CE

(You will receive an email to confirm your subscription)

I consent to KWETB CE using my photo and/or video recording of me to promote their work *

I acknowledge that the above details are correct. Your name and date: *