Extended Campus Application Form

* Indicates a mandatory field which must be completed

Programme Details

Programme Title *

Personal Details

Please Note: The name you enter will appear on any parchment to which you may be entitled to.

Surname *

First Name(s) *

Address Line 1 *

Address Line 2

Address Line 3

County *

Eircode *

Country of Residence *

PPS Number *

Gender * Male Female Non Binary Prefer not to say

Date of birth *

Country of Birth *

Country of Citizenship *

Is English/Irish your first Language? * Yes No

Home Telephone

Mobile Number *

Work Number

Email *

Have you previously been a student in IT Carlow? * Yes No

If yes please state:

Programme Title

Year you finished Programme

Student number

Qualification Record

The following information requested is for admission and statistical purposes only and will be treated in the strictest confidence.

Indicate the last Educational Institution attended * Secondary School Irish University Irish Institute of Technology Post Leaving Cert College Other

If Other, Please Specify

Indicate the Highest Qualification Achieved * Junior Certificate Leaving Certificate QQI/NCVA Apprenticeship Ordinary Degree Honours Degree PLC Qualification Masters Other

If Other, Please Specify

Proof of Qualifications
Proof of qualifications needs to be attached when returning application form to the Extended Campus.
If you are under 23 years of age, you will need to provide a copy of the Leaving Certificate or Full Level 5 qualification obtained.

Are you are attaching a copy of your qualifications? * Yes No

Click here to attach file
must be smaller than 2MB

Do you have a Disability/Specific Learning Difficulty? * Yes No

If Yes, Please Advise *

Please Note: This information is required to ascertain what supports that you may require to facilitate you as a student.

Employment/Recognition of Prior Learning (RPL) Details

Are you Employed * Yes No

If yes, please add employer details below

Name of Employer *

Employer Email address *

Postition Held *

Employment Start Date * dd-mm-yyyy

RPL is a process that allows you to gain admission to a programme of study or to gain exemptions/credit from some parts of a programme.

This is based on demonstration of learning that you may have achieved through another programme of study, through work or other learning experiences.

Please contact the Extended Campus office on extendedcampus@itcarlow.ie to request an RPL application form.

Programme Fees

Please Note: Fees must be paid before commencement of programme. Once your application has been processed you will be contacted by Extended Campus with regards to making a payment.

Please indicate if an organisation is paying part or all your fees * Yes No

If an organisation is paying your fees, confirmation must be provided from that organisation and if possible, attached to this application form.
The amount of funding being provided must be indicated.

Click here to attach file
must be smaller than 2MB

Please note: Programmes run subject to sufficient numbers. If a programme does not run, a full refund will be offered.

Applicant Declaration

Applicant Declaration

I declare that the information given by me in this application is true and accurate and that if accepted I agree to read and abide by the regulations of Institute of Technology Carlow.

I hereby agree that the Institute may use my photograph in publications of the Institute where they judge this to be in the best interest of either myself or the Institute.

I understand that the Institute of Technology Carlow will treat all information as confidential and will not disclose such information except as permitted by Law.

Other information provided will be held and will only be used for purposes registered under the General Data Protection Act.

Agree with Declaration? * Yes

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Please click Submit once only.
It may take up to 30 seconds for the submission to be processed.

The Institute of Technology Carlow is committed to protecting the rights and privacy of individuals with respect to the processing of their personal data. A copy of the Institute’s Privacy notice is available on the Institute’s website (https://www.itcarlow.ie/resources/data-protection.htm). This website also contains further information relating to your rights regarding subject access requests, records retention and data protection in general. Any further queries in relation to the GDPR can be addressed to the Institute’s Data Protection Oversight Group (e-mail: gdpr@itcarlow.ie)