NUI Matriculation Exemption Form 4

You must complete all items marked with a red asterisk * below.

First Name *

Surname *

Address *

Date of birth *

Telephone Number *

Main Email Address *

Confirm Main Email *

Alternative Email Address

Confirm Alternative Email

Exemptions for which you wish to apply *

Prospective Year of Entry to University *

Current CAO Application Number

Leaving Certificate Year *

Leaving Certificate Subjects & Levels

1. *

2. *

3. *

4. *

5. *

6. *

7. *

8. *

Attach your Dept. of Education Certificate of Exemption file in pdf or jpg format *

Attach the Declaration from your school Principal in pdf or jpg format *

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