Access Alumni Disclosure Consent Form

To enable the Access Programmes Office to coordinate with the University’s Alumni Office for the purposes of establishing an Access Alumni Group, it will be necessary for the Access Programmes Office to disclose relevant information to the Alumni Office, having obtained the Graduate Student’s consent to do so.

NUI Galway Access Programmes are requesting its Access Graduate Students to disclose information regarding their contact details to the Access Programmes Office.

Such disclosure is encouraged so that the NUI Galway Alumni Office can work with the Access Programmes Office to support it to establish an Alumni group specifically for Graduates Students who have participated in one of the University’s Access Programmes.

Any documentation or information presented in the Graduate Student’s disclosure is held by the Access Programmes Office, which is part of the Access Centre at NUI Galway. All information provided to the Access Programmes Office is regarded as ‘sensitive personal data’ and an electronic record of the Graduate Student’s contact with the Access Programmes Office is held securely in accordance with the Data Protection Act (1998-2018).

All information provided to the University is treated in a sensitive and confidential manner and is covered under the University Data Protection policy and therefore only relevant information to the particular situation will be disclosed to the University’s Alumni Office.

I have read and understood the above and I hereby consent to information relating to my personal details (e.g. name, student number, Access Programme, home address, other address, email details) being forwarded from the Access Programmes Office to the Alumni Office as appropriate.

In addition, I consent to the submitting of email, handwritten and/or video testimonials which could subsequently be used for electronic publicity material (websites, social media) and/ or hard copy publications (newspapers, magazines) for the purposes of promoting Access Programmes.

1. I consent to information relating to my personal details being forwarded from the Access Programmes Office to the Alumni Office for the purposes of establishing an Alumni Group

2. In addition, I consent to the submitting of email, handwritten and/or video testimonials which could subsequently be used for electronic publicity material (websites, social media) and/ or hardcopy publications (newspapers, magazines) for the purposes of promoting Access Programmes.

3. Please tick which applies to you?

I am a graduate of NUI Galway
I am currently an undergraduate of NUI Galway

4. If you are an 'UNDERGRADUATE', please state year in which you expect to graduate:

5. In what year did you complete the Diploma in Foundation Studies (DFS) Access Programme?

7. First Name:

8. Surname:

9. Address Details:

Address 1

Address 2

Address 3

10. Email Address:

11. Phone Number:

Signed:

Thank you for completing the form.

Access Alumni - NUI Galway