Caring for a Small Blue planet Short Course

Hello All

We are running another short course on Caring for a Small Blue planet commencing this May, Attached is the flyer and the application form, there are only a limited number of places available so if you are interested please print off the application form and return to the office to book your place, or if you know anyone who might be interested please advise them to do the same.

Many thanks Ger

Geraldine Flanagan

Programme Administrator,

Social and Health Education Project,

The Village Centre, Station Road,

Ballincollig, Co.Cork

Phone: 021-4666180 Fax: 021-4870104.

The Social and Health Education Project

Cork Short Community Education Courses

May-June 2017 Application Form

Applicant’s Name:                                                                                                               

Home Address:                                                           Work Address:                               

                                                                                                                  

                                                                                                                  

Home Phone:                                                              Work Phone:                                   

Mobile Phone:_____________________                  E-mail Address:__________________

Where did you hear about the courses?  ________________________________________________________

If referred to the course by another person please specify? ______________________________

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

Where applying for a course for which there is No Charge*, if it applies to you, please provide a copy of a recent welfare payment, as some priority in allocating places will be given to this.

I wish to apply for the following course  (Please √)                     Please indicate your 1st & 2nd preference if applying for more than one

VENUES – The Lantern, 14 Georges Quay, Cork ·         Caring for a Small Blue Planet   (Thursdays 7-9.30pm & One Saturday)                  – No Charge □

·         Applications are only processed when submitted on a completed Application Form.

·         Generally places are allocated in order of application and courses run subject to numbers applying. You will be notified in advance whether you have secured a place

·         Course at No Charge are funded through a variety of sources including donations, voluntary time and partnering of resources between groups such as CETB, HSE, The Lantern, RESPOND, Ireland fund and SHEP. Courses with a * Subject to funding.

·         SHEP treats information gathered via this form confidentially, storing it electronically and in hard copy, using it internally for course management and programme evaluation. Contact information is shared with the Lantern and RESPOND co-ordinator where that is the venue for the course.

Signature:____________________________       Date:_____________

Please return this Application Form to Programme Administrator, The Social and Health Education Project, Village Chambers, Village Centre, Station Road, Ballincollig, Co. Cork (021-4666180)