e brochure and WEB application form 2011 2012 by y1Do708


                          NATIONAL COLLEGE OF IRELAND

                                PLEASE USE BLOCK CAPITALS

Family Name/Surname            _____________________________________________

First Name                     _____________________________________________

Country of Birth _________________          Nationality_________________________

Female          Male                        Date of Birth
                                                            Day   Month     Year

Applicant’s Address            _____________________________________________



Contact Tel:    ___________________         Contact E-mail: ____________________

Agent Name (if any)      __________________________________________________

Course choices at National College of Ireland (NCI)

Preference   Title of Course                                       Date to Start

Applicant Educational Background/Academic Studies
Secondary/High School (or equivalent)
Name of School             Attended   To date:    Qualification
                           from date:

Applicant Third Level/University Level Education (if any)
Name of Institution        Attended       To date:     Qualification
                           from date:

Applicant English Language Level Certification
       TOEFL IELTS TOEIC NCI TELL ETAPP Other (please State)

Applicant Employment History (if any)
Name of Employer          Position Held                                    Date
NCI staff will be happy to arrange on campus accommodation in student halls of residence for
international students.

Please tick here if you would like NCI to organise your accommodation here. If you have your
own accommodation please leave blank.

On Campus Accommodation

Do you have any medical conditions that should be made known to NCI?

                   Yes                    No

If so, please list and describe

How did you hear about NCI?


Applicant’s signature:                                            Date:

All information supplied to you will be stored on computer and will be used for internal purposes
only. Details will not be passed on to third parties.
Please confirm that the particulars given in relation to this application are in all
respects true and if offered a place at NCI, you will abide by all college rules and

Please note:

    1. This application form fully completed, must be returned to the International Office,
       National College of Ireland, Mayor Street, IFSC, Dublin 1, Ireland.
    2. Please attach certified translated copies of all relevant examination certificates including
       evidence of proficiency in English.(Please see our web site www.ncirl.ie for information
       regarding entry requirements)
    3. Please attach a copy of your birth certificate.
    4. A passport-size photograph must be attached to this form.
    5. Completion of an application does not guarantee a place on a course.
    6. For details of fees please see web site www.ncirl.ie

Contact Details:                  The International Office
                                  National College of Ireland
                                  Mayor Street IFSC
                                  Dublin 1

Tel: +353 1 4498695/63/53         email: international@ncirl.ie
Fax: +353 1 4972200               web: www.ncirl.ie/Prospective_Students/International-Students

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