Test ICHAS - Application Form Application Form Name*ForenameSurname Address Street Address Street Address Line 2 City County / Province / Region Postal / Eir Code AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWalesYemenZambiaZimbabwe Country Phone Mobile* Select One*EU CitizenNon-EU Citizen Date of Birth*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 2018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year GenderMaleFemale Email* Textarea* Please note that a large proportion of correspondence from the ICHAS is through email. For this reason, an application form cannot be processed without a valid email address. By making an application to the College, you are indicating that you understand this and that you have access to an email address that will be checked regularly. Please contact us by telephone if you require any assistance in this regard. Course or Programme you wish to apply for:*Select oneCertificate in Counselling & Psychotherapeutic Skills & PracticeB.A (Hons) in Counselling and Psychotherapy B.A. in Counselling Skills and Psychotherapy Studies B.A (Hons) in Counselling and Youth Studies B.A in Counselling Skills and Youth Studies B.A. (Hons) in Counselling & Addiction Studies B.A. in Counselling Skills & Addiction Studies B.A. (Hons) in Childhood and Adolescent Care & PracticeCertificate in Childhood Practice Higher Certificate in Childhood & Adolescent PracticeHigher Certificate in Business B.Bus in Business B.Bus(Hons) in Business with Business PsychologyM.A. in Counselling and Psychotherapy M.A. in Cognitive Behaviour Therapy M.A. in Counselling and Pastoral Care M.A. in Clinical Supervision in Professional Practice M.A. in Childhood and Adolescent Studies M.A. in Leadership and ManagementM.A. in Addiction Counselling Study Method*Full-TimePart-TimeImportant: Full-Time courses are presented at our Limerick and Dublin Campuses only. Preferred Campus Location*Select valueDublinLimerickWaterfordTraleeGalwaySligo By ticking this box I agree to consent to ICHAS sharing the data contained in this application form with Griffith College Dublin, for the purpose of processing my application to study with ICHAS at it's Dublin CampusI ConsentDetails of EducationSome programmes offered by ICHAS have particular entry requirements and applicants are advised to refer to the prospectus or website for any recommendations regarding prior learning or experience. The information in this section will help us to determine if you may be entitled to any exemptions or credit allocation based on prior learning, or experience.Education Most Recent Second Level School/College Attended Attended From - To (mm/yy) Latest 2nd Level AwardSelect valueIntermediate CertificateJunior CertificateLeaving CertificateOther 2nd Level Year Completed Ordinary SubjectsNo.12345678 Honours SubjectsNo.12345678Educational Qualifications(University, College, Institute of Technology, Leaving Cert, C&G, FAS etc.) DetailsCollege/InstituteFrom - To (mm/yy)Course/ProgrammeAwards/Results1234Important:Pending the offer of a place on one of our courses you will be required to provide copies of certified results for all Qualifications/Results mentioned above. Results of relevant examinations to be taken/courses yet to be completed should also be provided.Employment RecordPlease provide details of employment, internship, or volunteer work that you feel might be relevant to your application. RecordEmployer/OrganisationEmployed From - To (mm/yy)Position/Role123Supporting StatementPlease indicate the reasons why you wish to pursue a Degree with ICHAS. You should state all information that may be relevant to your application, e.g. previous experience, volunteer work, reasons for your interest in your chosen subject area etc. You may also upload your Statement as a separate document by clicking HERE StatementSpecial RequirementsICHAS makes every effort to accommodate learners with disabilities, whether physical, learning or otherwise. Such applicants are invited to contact the Administration Office in writing with details of the nature and extent of the disability. The application will be handled in line with ICHAS’ Equality Policy and any disclosure will not adversely affect the application. This will allow us to give you the best advice prior to application.Recognition of Prior Learning (RPL)If offered a place as part of the RPL process you will be required to produce details of formal and informal learning experiences relevant to your application that you feel may support your application or entitle you to exemptions from course or programme modules.These can be in-company training courses, external general interest courses you pursued of your own accord, or skills acquired from volunteer work. Please indicate what you learned from such experiences and how they contribute to your application. Examples of such personal learning outcomes may include professional skills, time management skills, study skills, organisational skills, assertiveness, empathy, confidence, numeracy, writing skills, knowledge of particular subject areas, team skills and so on.Garda Vetting Process Garda Vetting ProcessIt is a requirement that all students consent to current Garda vetting procedures. Please tick the box to indicate your consent to this*I ConsentInterview Consent InterviewBased upon the course or programme applied for, prospective students may be called for interview. Please tick the box to indicate your consent *I ConsentBlended Learning Requirements Blended Learning & IT RequirementsElements of some modules may be delivered through our Blended Learning Environment incorporating online/web based interactive learning. This means students will engage with some learning through face to face sessions and additional learning will be delivered through a virtual learning environment supported by highly qualified lecturers. In order to use web based interactive learning resources, you will require access to a suitable desktop or laptop computer, and access to the Internet. Minimum specifications are listed here. Please see the online Blended Learning FAQ for further information. Please tick the box to confirm that you understand this requirement:*I UnderstandFees & Payment I agree to pay my Application Fee of €100 now*Pay DepositDeclarationI declare that I have read and agree to the Terms and Conditions and that the information given by me in this application is true and that if I am admitted as a student I will abide by the regulations of the Irish College of Humanities and Applied Sciences. ICHAS reserves the right not to consider applications and to cancel any offers of places where requested information has not been supplied or falsified; or misleading information has been supplied. Tick this box to digitally sign this declaration: *Sign Type your Signature here:* Type in these charactersSubmit ApplicationReset