Interact Is a Programme Designed to Improve the Job Prospects of Students with Disabilities

University of Limerick

OLLSCOIL LUIMNIGH

Student Application Form

Interact is a programme designed to improve the job prospects of students with disabilities.

Personal Details:

The information provided on this form will remain confidential to the Interact Programme

First Name:

Surname Or Family Name:

Term Time Address:

Telephone:

E-mail Address:

Home Address:

Telephone:

Date of Birth://

Gender: [please tick]MaleFemale

Disability Status:

This programme requires that you have a disability (the Disability Discrimination Act 1995 defines disability as “ a physical or mental impairment which has a substantial and long-term adverse effect on ability to carry out normal day–to-day activities.”)

Please give details of your disability:

I give permission for this information to be made available to potential mentors:

YesNo

Education:

Please indicate your: a) Current year of study b) Expected year of graduation

Please give the full title of your current degree/postgraduate course:

What class of degree do you expect to achieve or have achieved?

How did you hear about the Interact Programme?

Work Experience:

Please give details of your work experience including your most significant part-time temporary jobs.

Name of EmployerFrom ToJob Title

Career Aspirations:

Please briefly outline the type of work and type of employers you plan to apply to on graduation:

Please briefly outline why you wish to be involved in the Interact Programme and what you hope to gain from your participation:

Employer Partners:

Through the Interact Partnership Programme we will endeavour to match you to an employer. Your answers to the following questions will help us to identify the most appropriate mentor to support you.

Gender.

Please tick if you have a preference for working with a male or female mentor.

Male PreferenceFemale PreferenceNo Preference

Employment.

Do you have a preference for working with a mentor from a particular employment sector?

YesNo Preference

If yes, please specify the employment sector and organisation you would prefer to be matched with, e.g. accountancy in the public sector, computing in industry.

Please List at Least Three Options.