SCPD application form MID- WEST (Limerick,Clare, Tipperary) Regions

SHEP CERTIFICATE IN PERSONAL DEVELOPMENT APPLICATION FORM – MID- WEST (Limerick,Clare, Tipperary) Regions –

Step 1. – (Important) Before proceeding with the application, it is important that you read the following 2 documents

>> PLEASE READ FIRST – DATA PROTECTION – How SHEP manages information of course applicants. <<

>> PLEASE READ FIRST – Information on SHEP Fees, Reduced Fees, Funded Places & Payment Methods <<

Step 2. – Please review the apropriate funding streams for your circumstances

Please choose Tab A in Step 3 if you are paying for a full fees place (€790).

‘Tab A’ Notes (Click – sign to drop down)

For the full fee option, the applicant pays all of the fee themselves.

Payment plans are available from the accounts dept. (accounts@socialandhealth.com)

Payment can be made via the SHEP website or bank transfer, all major credit and debit cards excepted.

Please select Tab B in Step 3 if you are choosing to apply for a reduced fee place (€490).

‘Tab B’ MW Notes (Click – sign to drop down)

Eligibility for a reduced fee place is for individuals who are:

1) In full-time education and experiencing financial difficulties

2) Experiencing financial hardship

>> PLEASE READ – Reduced fee and funded places notes above.<< )

Please select Tab C in Step 3 if you are choosing to apply for a Bursary place (€190).

‘Tab C’ MW Notes (Click – sign to drop down)

Due to the nature and source of this financial support Bursary places are allocated ONLY for individuals on Social Welfare payments.

These places are subject to availability, for further details click the link above – >> PLEASE READ – Reduced fee and funded places notes above.<<

If you need assistance in any way to complete this form or further information please phone (021) 466 6180

Step 3 – Select chosen funding ‘Tab’ and fill out form

Tab A) Full Fee Place {€790}
Tab B) Reduced Fees Place {€490}
Tab C) Bursary Place {€190}

Tab A) Full Fee Place {€790}

Full Fee Place Application Form SHEP Cert in Personal Development (€790)

First Preference:

Second Preference:

Applicant's Name:

Home Address:

Home Phone:

Mobile Phone:

Email Address:

Date of Birth:

Occupation(If Applicable):

Emergency Contact Name:

Emergency Contact No:

Briefly outline your interest in applying for this course?

How did you hear about this course?

Have you completed any previous courses on any aspect of health-education, personal development or group work? Please specify:

Do you have any special needs or medical conditions that we should be aware of for practical purposes? If yes, please provide additional information:

Are there any additional supports you need to participate in this course?

Is there any other information about yourself that you would like SHEP to know?

DATA PROTECTION :
I have read and I understand the Data protection statement, important information on SHEP fees, reduced fee/funded places & payment method documents.

CONSENT :
I understand and give my consent to how SHEP will use my personal data.

SHEP MAILING LIST :
Please indicate if you wish to join SHEP's Mailing List to receive information about project news and future programmes. You can 'Unsubscribe from the SHEP Mailing List at anytime.
Please add me to SHEP's mailing list.

Please attach a passport photograph here:

To attach a photo:
1) Take a profile shot of yourself with your smartphone/tablet or get someone else to take it for you.
2) If you are applying for the course on your smart phone or tablet when you 'choose file' you will be given the option to
select the image from the gallery on your device.
3) If you are using a laptop or PC to make the application then complete the following steps:-
4) Email the photo to your own email account from the smart phone or tablet
5) Access the email account on the machine that you are applying from
6) Open the email and download the photo to your desktop or downloads section of your device.
7) Click 'Choose File' and a browser window will open that will allow you to locate the file on your machine.

Tab B) Reduced Fees Place {€490}

Reduced Fee – Application Form – SHEP Cert in Personal Development (€490)

Before proceeding with your application please read the funded/reduced fee notes above.

First Preference:

Second Preference:

Applicants Name:

Your Address:

Home Phone No:

Mobile No:

Email:

Date of Birth:

Occupation(If Applicable):

Emergency Contact Name:

Emergency Contact No:

Briefly outline what is your interest in applying for this course?

How did you hear about this course?

Have you completed any previous courses on any aspect of health-education, personal development or group work? Please specify:

Do you have any special needs or medical conditions that we should be aware of for practical purposes? Please specify:

Are there any additional supports you need to participate in this course?

Is there any other information about yourself that you would like SHEP to know?

I am applying for a reduced fee, on the basis that:

I am a full-time student:
YesNo

If yes please state name of course and college, if no leave blank:

I would like to apply on the grounds that I am experiencing financial hardship:
YesNo

If yes please set out your grounds for this, if no please leave blank:

In the case of a reduced fee place not being available you will be offered a full fee place.
Please highlight your preference below –

Option 1

DATA PROTECTION :
I have read and I understand the Data protection statement, important information on SHEP fees, reduced fee/funded places & payment method documents:

CONSENT :
I understand and give my consent to how SHEP will use my personal data above.

Tab C) Bursary Place {€190}

Bursary Application Form – SHEP Cert in Personal Development (€190)

The Bursary Fee application form is available to those on social welfare payments.

First Preference:

Second Preference:

Applicants Name:

Your Address:

Home Phone No:

Mobile No:

Email:

Date of Birth:

Occupation(If Applicable):

Emergency Contact Name:

Emergency Contact No:

Briefly outline what is your interest in applying for this course?

How did you hear about this course?

Have you completed any previous courses on any aspect of health-education, personal development or group work? Please specify:

Do you have any special needs or medical conditions that we should be aware of for practical purposes? Please specify:

Are there any additional supports you need to participate in this course?

Is there any other information about yourself that you would like SHEP to know?

I am applying for a Bursary fee, on the basis that:

I am a Social Welfare recipient:
YesNo

If yes please state name of payment if no leave blank:

In the case of a reduced fee place not being available you will be offered a full fee place.
Please highlight your preference below –

Option 1

DATA PROTECTION :
I have read and I understand the Data protection statement, important information on SHEP fees, reduced fee/funded places & payment method documents:

CONSENT :
I understand and give my consent to how SHEP will use my personal data above.

SHEP CERTIFICATE IN PERSONAL DEVELOPMENT APPLICATION FORM – MID- WEST (Limerick,Clare, Tipperary) Regions –

Step 1. – (Important) Before proceeding with the application, it is important that you read the following 2 documents

Step 2. – Please review the apropriate funding streams for your circumstances

‘Tab A’ Notes (Click – sign to drop down)

‘Tab B’ MW Notes (Click – sign to drop down)

‘Tab C’ MW Notes (Click – sign to drop down)

Step 3 – Select chosen funding ‘Tab’ and fill out form

Tab A) Full Fee Place {€790}

Tab B) Reduced Fees Place {€490}

Tab C) Bursary Place {€190}

Tab A) Full Fee Place {€790}

Full Fee Place Application Form SHEP Cert in Personal Development (€790)

Tab B) Reduced Fees Place {€490}

Reduced Fee – Application Form – SHEP Cert in Personal Development (€490)

Tab C) Bursary Place {€190}

Bursary Application Form – SHEP Cert in Personal Development (€190)

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