SHEP Cork Short (8 week) Community Education Courses
Spring 2024 Application Form
Applicant’s Name:
Address:
Home Phone:
Mobile Phone:_____________________ ______ E-mail Address:_______________________
Who to call in case of emergency: Name __________________ Number ___________________
Where did you hear about the courses? _____________________________________________
If referred to the course by another person, please specify? _____________________________
Why are you applying for the course? _______________________________________________
________________________________________________________________________________
Please specify if any special/medical needs that we should be aware of for practical purposes?
________________________________________________________________________________
Please specify any additional support you may need to participate (e.g. support with Zoom?)
_______________________________________________________________________________
If you wish, please provide a copy of welfare payment, as priority is given in allocating places
Please √ the Course Applied For (and 1 st & 2 nd preference if applying for more than one)
IN-PERSON – SHEP Project Centre, Ardfoyle, Ballintemple, Cork City (T12 Y304)
CN003871 – Managing Stress (Monday morning 10.30am to 1pm). – No Charge □
CN003872 - Seasons for Growth (Monday night 7.30pm to 10pm). – No Charge □
CN003874 - Effective Communication (Tues morning 10.30am to 1pm). – No Charge □
CN003873 - Introduction to PD (Wed night 7.30pm to 10pm). – No Charge □
CN003875 - Effective Communication (Thurs night 7.30pm to 10pm). – No Charge □
ON-LINE – Zoom On-line through SHEP
CN003877 – Managing Stress (Mon night 7pm to 9.30pm). – No Charge □
CN003876 - Introduction to PD (Wednesday nights 7.00pm to 9.30pm). – No Charge □
CN003878 - Seasons for Growth (Wednesday night 7.00pm to 9.30pm). – No Charge □
Where a course is over-subscribed, we give weighting to a number of factors,
details of which are available on the website or by phone. Applicants will be
contacted a week in advance of the commencement date with offers of places
On-line courses this Spring 2024, will have 14-16 participants max, and use
Zoom. Guidelines to all participants on accessing and using Zoom will be given
prior to course commencement - individual support is also available.
Applicants need to be age 18 years or over. Where an applicant, or the Project
wish to check out readiness to participate on a particular course, the co-ordinator
will arrange to talk this through and maybe meet the person
Please read info overleaf on ‘how we use personal data’ prior to signing
application. All above course tutor hours are CETB funded. Once course
commences, a registration form will also be asked to be completed.
Signature:__________________________________________ Date:_____________
Please return this Application Form to SHEP, Old National School, Ardfoyle Avenue,
Ballintemple, Cork (T12 XDH2) (021-4666180) or email to info@socialandhealth.com
How will SHEP use Personal Data of course
participants?
SHEP asks only for the minimum information from course applicants, sufficient enough to
process applications and course participations. You have rights in relation to your own
personal information used by SHEP, including right to object to processing and right of
access to your own personal information. We genuinely encourage you, if you have any
queries or concerns about how your personal data will used or stored, to talk with SHEP
training staff on 021 4666180 or email us at info@socialandhealth.com . SHEP’s purposes
for gathering information are:
To contact you about your application;
To follow up with you after the application is received and administer your
application as required;
To manage course processes (including commencement, completion, progressions,
course payments where relevant, course evaluations, project statistical reporting);
To maintain your participant training record (including personal & course details)
To share information with course facilitators, organisations involved collaboratively
in courses, or where there is a fee funding support being sought. Only necessary
information is shared and SHEP will be transparent with you.
Where information is to be disclosed beyond the purpose above, specific additional
consent will be sought from you
Participant information is stored on secure, protected cloud based and in-house specialised
training and education database. Hard copy information is stored in secured cabinets.
Information is only accessed for the above purposes and only accessed by authorised SHEP
training, administration and accounts staff.
As an applicant for one of SHEP’s courses, we ask that you read and understand the above
data protection statement and application form carefully. On this application form we need
your signature to:
1. Confirm that you have read, understood and give consent to how SHEP will store, use
and access the personal information you provide.
We are committed to ensuring that any information we collect is handled in accordance
with the principles set out in the General Data Protection Regulation (Regulation (EU)
2016/679) and the Data Protection Acts 1988 to 2018. SHEP’s detailed Data Protection
Policy and time scales for retention of information is available at
www.socialandhealth.com
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