Application Form 2013 - Part A

(Complete ALL entries in BLOCK LETTERS.) N.B. Read the Handbook carefully before completing this Form.

SURNAME

OTHER NAME(S)

Day Mth Year TITLE (if desired) (e.g. Ms, Mr, etc.)

Sex (F or M)

Date of Birth (ddmmyyyy)

ADDRESS FOR

CORRESPONDENCE

(Note: Only one address may be shown here)

Contact Tel. No:

COUNTRY OF BIRTH NATIONALITY

E-mail Address: Mobile No: (if different from Contact Tel. No: )

Name, Address,Years of 2nd Level Schools attended

If none attended, write “NONE”

Do you have a Disability/Specific Learning Difficulty? See Page 8. If relevant, please tick ( ) this box.

Do you wish to apply for the HEAR scheme? See Page 9. If relevant, please tick ( ) this box.

Republic of Ireland Examination Details

Will you sit the Irish Leaving certificate examination in 2013? You must write ‘Yes’ or ‘No’ in this box.

Year Exam No Year Exam No Year Exam No Leaving Cert. exams 1985 - 2012

If you are taking 2013 FETAC Level 5/6 , and/or have completed a FETAC Level 5/6 between 2002 and 2012, please enter your PPS Number in this box.

COURSE CHOICES Application may be made for up to ten Courses in EACH of the TWO categories below.

In BOTH cases, courses should be entered in order of preference. Take special care NOT to mix courses in the different categories.

Level 8 Level 7 & Level 6 Pref. Course Code Pref. Course Code

1 1

2 2

3 3

4 4

5 5

6 6

7 7

8 8

9 9

10 10

Please note that the HEIs you apply to may wish to communicate with you about your application, and they may contact you by email, post or SMS text.

Application Form 2013 - Part B (Complete ALL entries in BLOCK LETTERS.)

N.B. Read the Handbook carefully before completing this Form. (This page to be completed ONLY by Special Category Applicants)

VERY IMPORTANT.

Processing of your application may be suspended and an extra fee may be charged for correction if you have not followed the precise instructions on pages 11,12 and 13 of the Handbook about (1) the proper completion of these Special Categories Indicators and (2) the supply of any attachments.

SPECIAL CATEGORY: Tick ( ) whichever one or more of the following applies in your case.

You must consult pages 11, 12 and 13 of the Handbook before completing this section.

In the case of Category E, failure to disclose the appropriate information may result in the cancellation of the application. Checks are made to ensure that this information has not been omitted.

A

GCE/GCSE

( Post 1995 taken in UK/NI ONLY)

D FURTHER EDUCATION (Other than FETAC (Page 1) or NCVA Level 2/3)

B

OTHER S/L EXAMS (School leaving exams outside Ireland and UK

LCAP, GNVQs, VCEs, BTEC, HND, Irish Matric Exams, Scottish Exams and Irish LCE

pre 1985 or UK Exams taken pre 1996.)

E

HIGHER EDUCATION (Attended or attending a 3rd Level Institution,

i.e. Universities, Inst. of Tech, Coll of Educ, etc)

C

NCVA LEVEL 2/3

(Completed in 2001 or earlier )

F MATURE

(23 years old on or before January 1st 2013)

Please use additional pages to expand on each of the Special Categories that you have indicated above. Please read Pages 11,12 and 13 of the Handbook about what documentation needs to be

supplied.

GCE/GCSE EXAMS already completed and certified.

You must attach certified A4 photocopies of the appropriate certificates for any GCE/GCSE examinations which you have already completed and for which a certificate has been issued. GC(S)E forms part of your matriculation.

DO NOT SEND ORIGINALS as they will NOT be returned to you. GCE/GCSE EXAMS to be taken or certified in summer 2013. Board Centre No. Candidate No. Subject Level * Board Centre No. Candidate No. Subject Level *

CCEA

CCEA

CCEA

CCEA

* Enter level as follows: A = Advanced; S = Advanced Subsidiary; O = GCSE.