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.