CAN Communiversity Expression of Interest Form

Expression of Interest Form
ComMUniversity Programme

To be eligible participants must be residents of South County Dublin. Priority will be given to SDCP/CAN funder target groups - namely marginalised groups, those living in disadvantaged communities and parents of CAN schools/feeder schools. Please note participant information provided will be shared with CAN/SDCP and relevant third parties for intended purposes only in line with all GDPR guidelines*.
Name*
Address

Street Address

Street Address Line 2

City

Eirocode
Phone number *
email address (if none state none)*
If you have any school-going children in your family please indicate which schools (primary and/or post-primary) they attend?*

St Kevin's Community CollegeDeansrath Community CollegeCollinstown Park Community CollegeOther
Which of the following categories do you identify with (select all that apply)?

Over 23 years of ageDisadvantaged person/living in disadvantaged communityLone parentLow incomeAsylum seekers/International Protection applicantPerson with disability (physical and/or mental health)Roma CommunityIrish TravellerUnemployedHomelessRetired seniorWidowMigrant/Member of New Communities
Do we have consent to call, text or email you regarding this programme or a future ComMUniversity programme?*

YesNo
The programme will likely run on Wednesday mornings - which of these days of the week is your 'next best' option?

MondayTuesday
ComMUniversity Sessions will run once a week from 10-12.30 - please indicate you can make this time?

YesNo
I understand that 80% attendance is required for this programme in order to successfully complete and to receive an invitation to the 'graduation' event on Maynooth University campus

Yes, I understand the requirements and I am fully committed to an 80% attendanceI have competing interests on my time and I would have difficulty meeting an 80% attendance requirement
Date form submitted*

MonthDayYear
Date
What we do with your personal data and your rights

We require certain information from you in order to be able to provide you with a programme or service. This data is used for planning activities, reporting and statistical reasons. We retain and store your personal data in accordance with all legal requirements imposed on us. In order to process your personal data we need your consent. When we process your personal data on the basis of your consent you are free to withdraw that consent at any time. We do not share information with third parties but should any information need to be shared in order to provide you with a service it will always be with your consent. You have rights under data protection law to access, rectify, restrict or delete your personal data as well as to the portability of your data.
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Expression of Interest Form

ComMUniversity Programme