Find a Course Search Search Home / Higher Education Application Form Course Code/Title* When completing your online application the tab key will take you to the next field on the form. Personal Details Forename(s)* Surname* Title* Select Title Mr Miss Mrs Ms Dr Date of Birth* Gender* Male Female Email* Confirm Email* Contact Details Home Address* Home Address 2 Home Address 3 Postcode* Telphone Number* Mobile Number* Second Level Education (From age 16) Name of School/College* Start (MM/YYYY)* End (MM/YYYY)* Name of School/College Start (MM/YYYY) End (MM/YYYY) Name of School/College Start (MM/YYYY) End (MM/YYYY) EXAMINATIONS/QUALIFICATIONS TAKEN Qualification Level Year Gained Awarding Body Grade Achieved Add Another Row EXAMINATIONS/QUALIFICATIONS TO BE TAKEN Qualification Level Year Gained Awarding Body Grade Achieved Add Another Row Employment History Employers' Name and Address Duties From - To Full/Part-Time FULL PART-TIME Employers' Name and Address Duties From - To Full/Part-Time FULL PART-TIME Education Support The Northern Regional College welcomes applications from people with a disability, learning difficulty and/or medical condition. If you require additional support please complete an Education Support form (available on-line or from campus receptions) and return to the Education Support Co-ordinator at the campus where you wish to study. Who will be paying your fees? Self Employer Education & Library Board Other If Employer or other, please give name and address. Please note that Higher Education students are required to pay tuition fees for each year of their programme. You can apply to the appropriate Education and Library Board who will forward to you appropriate documentation for application to the Student Loan Company for a Fees Loan and/or Maintenance Loan. It is your responsibility to ensure that your tuition fees are paid. Should you fail to pay your tuition fees you may be withdrawn from your programme. Residency Country of birth if other than EU Date of entry to EU (if applicable) Additional Information Are you or have you been living in care? YES NO Please provide additional information which you would like to give in support of your application (eg. sports, hobbies, special interests, experience and your reasons for applying to this course). Continue on a separate sheet if necessary.
