Request Form for Information in Alternative Formats

Requestor details

Name: ______________________________________________

Address: ______________________________________________

______________________________________________

______________________________________________

______________________________________________

Telephone number: ______________________________________________

Email address: ______________________________________________

Information Details

Document title: ______________________________________________

______________________________________________

Format required: ______________________________________________

Intended use: ______________________________________________

Once completed, this form should be returned to:

Brenda Fallon

Human Resources Department

Quadrangle Building

NUI Galway

By e-mail: brenda.fallon@nuigalway.ie

Any queries regarding completing this form should be directed to Brenda Fallon at 091 493579, or at the above e-mail or postal address.