Magdalen Restorative Justice Ex-gratia Scheme Application Forms

• Published date: 01 July 2021
• Issuer: Department of Social Protection

Department of Justice and Equality

1

Magdalen Restorative Justice Ex-gratia Scheme

Application Form

In respect of women who were admitted to and worked in the 10 Magdalen

institutions as well as St. Mary’s Training Centre Stanhope Street and the House of

Mercy Domestic Training School, Summerhill, Wexford. A list of these institutions is

attached at appendix A.

 Please complete this form using BLOCK CAPITALS

 Please tick all boxes as appropriate

 Please note that failure to complete this form as fully as possible may delay

consideration of your application

 An acknowledgment will automatically issue within three weeks of receipt of your

application

 Please send the completed form to the following address:

Restorative Justice Implementation Unit,

Department of Justice and Equality, 3rd Floor, Montague Court,

7-11 Montague Street, Dublin 2

1. Personal Information

Surname: ………………………………………………………………………………..

Maiden name: ………………………………………………………………………………..

First name(s): ………………………………………………………………………………..

Any other first or

last name(s) used: ………………………………………………………………………………..

Any other name(s) by which you

were known in the Institution: ………………………………………………………………………

Date of birth:

Day

Month Year

Current Address: ……...………………………………………………………………………...

………………………………………………………………………………..

……...………………………………………………………………………...

Daytime telephone no: ………………………………………………………………………………..

Email address: ………………………………………………………………………………..

P.P.S./National Insurance no.* ……………………………………………………………….………

*mandatory