Art and the Natural Environment 

Name *

First Name

Last Name

Gender *

F

M

Option 3

D.O.B. *

Please enter your date of birth in the format of dd/mm/yyyy

MM

DD

YYYY

Mobile Phone *

Country

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

GDPR Consent *

We ask for the above information in order to be able to register you as a student should you be offered a place. All of the above information is required by Solas for you to be registered on their Programme Learner Support Service (PLSS). The information that you provide on this form is encrypted as it is passed from the website to our admissions system where it is stored securely and viewed only by authorised staff. We also use your email to activate an automated email confirmation ticket so you're sure that your application has been received. We use the secure MailChimp service to do this. We would like to retain your email on our MailChimp account so we can stay in touch with you in the future. This could be to inform you of exhibitions, film programmes in our community cinema, artist opportunities and so on.

Yes, I consent to my application information being used as described above.

Yes, I consent to my email being used for future communication as described above.

No, I do not consent to my email being used for future communication.

Medical Card

Are you a medical card holder

Yes

No