CREATE ACCOUNT

*

*

*

*

*

*

FORGOT YOUR PASSWORD?

*

Page 1 of 3

Facilitator Application Form

Name:(*)
Please let us know your name.

Address:(*)
Invalid Input

Email:(*)
Please let us know your email address.

Mobile/Phone:(*)
Invalid Input

(where applicable):

Teacher Council no:
Please write a subject for your message.

 
Qualifications:(*)
please fill the from

Experience in course facilitation/delivering with adults:
Please let us know your experience in course facilitation.

List the areas of expertise in which you are willing to deliver workshops:
enter your areas of expertise

List the Education Centres/other organizations where you have facilitated courses:
Invalid Input

 
Referees (Professional) and contact details (Name, Address & Mobile Phone):

Referees 1:
Invalid Input

Referees 2:
Invalid Input

Are you willing to have your details shared on the Education Centre Network database?(*)

Invalid Input

Statement re delivery of courses;
In the case where the education centre provides training, I agree to deliver as required for a minimum period of two years

Signed:
Invalid Input

Date:
Invalid Input

Statement re car Insurance

Declaration
I am aware that the Education Centre or the Department of Education & Skills accept no liability for any loss or damage that may result from the use of my motor vehicle in travelling to attend any event at the Education Centre. I have read these Expense Claim Form Notes and I acknowledge that the motor vehicle used is insured by me for the purposes of the Road Traffic Act, 1961. I certify that the expenses charged have been actually and necessarily disbursed in relation to my attendance at the above course and that I was in full-time attendance.

Signed:
Invalid Input

Date:
Invalid Input

captcha(*)
captcha   RefreshInvalid Input

TOP