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Apply by Friday, 15th May 2020 at 5pm

GMIT awards up to twelve financial scholarships to the value of €5,000 each to support students entering GMIT who are from socio-economically or other disadvantaged backgrounds, or those who have faced difficult personal circumstances. This financial scholarship is provided in increments over the duration of the programme of study.

In addition, scholarship applicants may be eligible for a reduced-points offer of up to 50 CAO points, subject to availability.

Note: Applicants must have taken the Leaving Certificate exams within the last two years.

A candidate must satisfy the following conditions: 1. Be an EU citizen.2. Have taken the Leaving Certificate exams within the last two years.3. Be a current applicant for a GMIT programme through the CAO and satisfy the general

and specific criteria for entry.4. Have family income under the current threshold for the third-level maintenance grant

scheme.5. Be supported by an academic reference from his/her school.

Criteria for Selection

• Completed application form.• Compliance with conditions specified at 1, 2, 3, 4 and 5 above.• Leaving Certificate points within 50 points of the first-round cut-off points for the

chosen programme.• Academic reference.• Interest, knowledge and commitment to the chosen programme.• Socio-economic factors considered:

- geographical relocation to attend GMIT- lone parent family- exceptional circumstances- social welfare/low income- applicant is the first member in family to attend third level education

Nominated candidates may be short-listed. Those short-listed will be interviewed in August (following Leaving Certificate results and CAO first round offers).

ACCESS SCHOLARSHIP FORM

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PERSONAL INFORMATION

CAO Application Number

Country of Birth: Are you an Irish Citizen: Yes No

If you ticked no, please explain:

EDUCATIONAL INFORMATION

Second Level Attendance

Dates Attended School(s) Attended From: To:

Please give your name as it appears on your CAO Form

Full Name: FirstName:

Surname:

Correspondence Address & Eircode:

Home Address& Eircode:

Insert your contact mobile number below: Insert below the contact number of a parent/ guardian:

Email Address: Date of Birth:dd/mm/year

What gender do you identify as? (tick one) Nationality/Citizenship Status:

Male Female Other

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Second Level Examinations

Junior Certificate Year: (insert dd/mm/year)

Leaving Certificate Year: (insert dd/mm/year)

Subject Level Grade Subject Level Grade

List the GMIT courses you applied for - in the same order of preference as your CAO Form

CAO Course Code GMIT Programme Title

2.

3.

4.

5.

6.

7.

8.

9.

10.

1.

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PERSONAL STATEMENT

In this section, we want to learn more about you.

In the Personal Statement, describe (using a maximum of 200 words) why you wish to pursue a third level programme of study, and the challenges or difficulties you experience in relation to your personal life (this will assist in the assessment of your application).

Describe:

- How these challenges or difficulties have affected your preparation for the LeavingCertificate

- How these challenges or difficulties might impact your transition to third level education- How you think these challenges or difficulties could be made easier with the right

supports in place

Please type here:

Note: If you are handwriting your personal statement, you can insert additional pages in your hard copy.

Interests and Hobbies Please give a brief description of interests and hobbies that you enjoy in your spare time

What do you enjoy?

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FAMILY AND INCOME DETAILS (to be completed by Parent(s) or Guardian)

Household Income for 2019

In this section, we will ask you questions on Family Income and Family Size (dependents)

In order to fully assess your scholarship application, you must provide proof of household

incomerelating to 2019.

All relevant proof of income documents must be submitted together with the application form as

the form cannot be assessed without these and will be returned to the applicant.

• SUSI Assessed Reckonable Income 2019, OR

• If on Social Welfare – A statement from the Social Welfare Office stating the total amount

received in 2019 (Back to Education, Job Seekers Allowance,

Carers/Disability Allowance, Lone Parents Allowance, FIS, Farm Assist, Rent Allowance,

Child Maintenance, Fuel Allowance etc.)

- These documents can be accessed by making a request on

www.welfare.ie.

- You will be required to quote your PPS number.

• If Employed – A P21 (End of Year Statement) for 2019

- This document is available on www.revenue.ie.

• Income from employment (including benefit-in-kind and directorships)

• Rental and other income from land and property

• Income from pensions

• Income from savings, deposit accounts and investments

• Lump sum payments from retirement and redundancy

• Income from the disposal of assets or rights

• Gifts and inheritances (you must fill out gifts/inheritance table)

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• Income from other sources not mentioned above

• If Self Employed/Farmer – A Notice of Assessment for 2019

- This document is available on www.revenue.ie.

Documents needed from Parent(s)/ Guardian (to be attached with this form)

1. If employed in 2019, please upload a P21 (End of Year Statement) for that period (this form can be accessed from Revenue)

2. If on Social Welfare, upload statement from Social Welfare Office stating total amount received in 2019

3. If Self Employed/Farmer in 2019 - please upload:

o Your Revenue Calculation Statemento Breakdown of your Profit & Loss Account

Please list the occupation(s) of Parent(s)/Guardian

Father Mother Guardian

Occupation

Family and Dependents

NameFirst Name & Surname

Surname)

Date of Birth

(dd/mm/year)

Relationship to

Applicant

Is this person

currently living in

the family home?

Yes or No

Highestlevel of educationachieved to date *

Current/most recent occupation or current place of study

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*Level of education i.e. Primary education, Group/Inter/Junior Certificate, Leaving Certificate, PLC, AdultEducation, Certificate, Diploma, Degree, Master’s Degree, etc.

PLACE OF RESIDENCE (Please tick the appropriate box)

Home Owner Private rented accommodation

Local Authority tenant purchase Local Authority rented flat

Scheme Local Authority rented flat Other non-permanent accommodation (please provide details)

Applicant Family Status (Please tick the appropriate box)

Married Single

Co-habiting Separated

Widowed Divorced

Unaccompanied adult Unaccompanied Minor

Other (please specify)

Medical Card (Please tick the appropriate box) Yes No

Do you have a full Medical Card?

Please enter your Medical Card number here.

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Do you have a GP Only Medical Card?

DECLARATION (must be signed by both applicant & his/her parent/guardian)

I declare that all the information provided is true, complete and accurate and refers to me, the applicant. I declare that assistance from other sources has not been received for the stated purpose/service which is the subject of this application.

I agree that all funding received will be used for the purpose intended.

I agree

Other

If you ticked ‘Other’ – please explain:

Signature of Applicant (type signature) Signature of Parent/Guardian (type signature)

Date: (dd/mm/year) Date: (dd/mm/year)

REMINDER: You must submit this completed form, including all relevant Financial Documentations and the Referee Report to GMIT by the closing date of May 15th 2020, at 5pm .

You can print out the Referee Report form (last two pages here) ask your school to download it from the GMIT Website. Please remember to attach all additional documents if emailing ATS directly.

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Referee Report (To be completed by the School Principal/Guidance Counsellor or Year Head.)

The completed Form should be returned by 15th May 2020 to:

POST TO:

Attract, Transition, Succeed (ATS) Office,

Student Services - GMIT

Dublin Road

Galway

Email: ats@gmit.ie

Name of Applicant: School Attended:

LEAVING CERTIFICATE PERFORMANCE 2020 (I predict the applicant’s performance in the Leaving Certificate examination will be as follows):

Subject Level of Exam (H/O)

Predicted Grade

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School Performance of Student (to be completed by the School Principal/Guidance Counsellor or Year Head)

Rating Description Indicators of Performance Very Good

Above Average

Average Below Average

Poor (Describe)

Motivation

Determination

Record of Attendance

Literacy Level

Numeracy Level

Adaptability/ Resilience

Coping Abilities

Additional Comments

1. What supports do you think the applicant would require in order to ensure success incollege?

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2. Is there any other information that would support the student’s application?

Signed: Position held:

Contact Number: Date:

Thank you for completing this report

Remember! Email or Post

1.Competed Form 2.Referee Report 3.All the necessary FinancialDocuments

Email: ats@gmit.ie Post: Attract, Transition, Succeed (ATS) Office Student Services – GMIT Galway Campus Dublin Road Galway