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					                                                           INTERNATIONAL APPLICATION FORM FOR
                                                          FULL-TIME POSTGRADUATE PROGRAMMES
                                                                       (To be completed by Non-European union applicants only)
                                         Please complete this form in BLOCK LETTERS and return to:
                                         q International Student Office

                                            Dublin Institute of Technology
                                            143-149 Rathmines Road
OFFICE OF GRADUATE STUDIES                  Rathmines
                                            Dublin 6
        APPLICATION NUMBER                  Tel:    + 353 1 402 7501/3435.
                                            E-mail: international@dit.ie
                                             Fax:      + 353 1 402 7533                                           AGENCY
                                             Web:      www.dit.ie/international                                    STAMP
           DATE RECEIVED                 q   Do not leave blanks – Enter
                                             N/A ("Not Applicable") as
                                             appropriate.

        FOR OFFICE USE ONLY              q   Please note that an individual
                                             may apply for up to 4 programmes.
Title of Programme(s) you wish to apply for:
               Programme Code(s)                                                         Programme Title(s)
   1.
   2.
   3.
   4.

                                                  PART I - PERSONAL DETAILS

 Family Name___________________________________ Given Names ____________________________________


 Date of Birth __________________________________                              Country of Birth _____________________________

 Nationality _____________________________________________                                         Male      ❒                   Female      ❒
 Address for Correspondence/Agency Address __________________________________________________________
 (This address will be used for all future correspondence - please notify the office immediately if there is any change to this address)

 ______________________________________________________________________________________________

 Tel: _________________________                Tel. (Mobile) __________________________ Fax: ______________________

 Tel (Work) : __________________________________                      email: ___________________________________________

 Permanent Address (if different): ___________________________________________________________________

 ______________________________________________________________________________________________

 Tel: ______________________________________                      Tel. (Mobile) ________________________________________


  IMPORTANT NOTICE TO APPLICANTS.
  Please submit the following:
  q    A copy of your final degree transcripts (Third level education only). Pending results must be supplied as soon as they are available.
       All offers will be subject to receipt of transcripts
  q    You may be required to furnish a full transcript of your academic career to date from the registrar of your university or other institution
  q    Evidence of Proficiency in English where your first language is not English (see Part IV)
  q    A copy of your passport page showing your photograph and personal details.
  q    Further information may be requested
  q    Applicants may be asked to attend for interview
  q    All documentation should be submitted in A4 format
  References are not required initially but may be requested at a later date.
                PART II – EDUCATIONAL BACKGROUND - THIRD LEVEL EDUCATION
                              (Please provide results to date if you have not yet graduated)

                                        Years of Study                                                Class of Qualification
   Names and Addresses                                           Programmes or                         (eg 1st Class Honours)
                                                                                      Qualification
   of Institutions attended     From:         To:                Subjects Passed                         Please state %/GPA
                                                                                                           for each subject




Examination to be taken or result pending. Please forward a transcript of the results as soon as they are available.




Notable academic achievements to date, prizes, medals, scholarships, honour awards, etc.




OTHER EDUCATION/TRAINING PROGRAMMES:
Please indicate any additional training programmes attended - Specify duration and level of award, if any, obtained.
Please add an additional page, if necessary.




MEMBERSHIP OF PROFESSIONAL ASSOCIATIONS, INSTITUTIONS, NATIONAL & INTERNATIONAL BODIES.

  Professional Association               Period of Membership             Level of Involvement & Grade of Membership




                       PART III - DETAILS OF ACHIEVEMENTS AND EXPERIENCE
PARTICULAR APTITUDES, ABILITIES, PUBLICATIONS AND RESEARCH INTERESTS.
(special aptitudes, knowledge of languages, computer skills, Publications, Reports, Dissertations, etc.).




State concisely why you consider that your application has particular strengths in relation to the programme applied for.
WORK EXPERIENCE RELEVANT TO APPLICATION (WHERE APPLICABLE)
Please indicate the post you have held, starting with your present post, and the nature of the experience acquired which
you consider may be appropriate in assessing the merits of your application for this programme.

Dates:                          From _____________________                     To _____________________

Title: ___________________________________________________________________________________________

Title of other positions held by you in the organisation ____________________________________________________

Name & full address of employer ____________________________________________________________________

_______________________________________________________________________________________________

Nature of Work __________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________


Dates:                          From _____________________                     To _____________________

Title: ___________________________________________________________________________________________

Title of other positions held by you in the organisation ____________________________________________________

Name & full address of employer ____________________________________________________________________

_______________________________________________________________________________________________

Nature of Work __________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

Dates:                          From _____________________                     To _____________________

Title: ___________________________________________________________________________________________

Title of other positions held by you in the organisation ____________________________________________________

Name & full address of employer ____________________________________________________________________

_______________________________________________________________________________________________

Nature of Work __________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

                                       PART IV - OTHER INFORMATION
 How did you become aware of the course for which you are applying?
 ❒       DIT Open Day       ❒ Graduate Fair (specify) __________________________________________
                                                                                               _________
 ❒       Advertisement
                            ❒ Educational Agent (specify) _______________________________________________
 ❒       Website
 ❒       Prospectus         ❒ Other (specify) _________________________________________________________


For Non-EU Nationals already living in Ireland:
Do you hold a study visa for the Republic of Ireland?       Yes   ❒           No   ❒
Please state the month _________________________ and year ________________________ you arrived in Ireland
Please supply a copy of your passport page with this application form.
PART IV - OTHER INFORMATION continued/...
 Overseas Applicants:

 Please state your native language: ________________________________________________________________

 Overseas applicants whose native language is not English must provide evidence of English proficiency, for example,
 the following qualifications will fulfil the Institute’s minimum requirements: (Note: Some programmes may demand a
 higher score).

 Qualifications:                                              Minimum level required:       Please Tick Box
 Irish Leaving Certificate                                    Ordinary Level (Grade D)             ❒
 TOEFL Paper-based test                                               550                          ❒
 TOEFL Computer-based test                                            213                          ❒
 TOEFL Internet-based test                                            80                           ❒
 IELTS                                                                6.0                          ❒
 GCE O Level English Language                                         Grade C                      ❒
 GCSE English                                                         Grade C                      ❒
 Cambridge Certificate of Proficiency in English                      Grade C                      ❒
 Cambridge Certificate in Advanced English                            Grade A                      ❒
 NEAB* test in English for speakers of other languages:               Pass                         ❒
 Warwick University English Language Test                             Pass                         ❒
 TOEIC (may be supplemented by an oral interview)                     700                          ❒
 Norwegian Vitnemal                                                   Grade 4                      ❒
 Other (please specify) ____________________________________________________________________________

 Where some or all of your Education has been through the medium of English, please provide details: _____________
 ______________________________________________________________________________________________
 * (Northern Examinations & Assessment Board – Formerly JMB)

NAMES OF TWO REFEREES (AT LEAST ONE OF WHICH MUST BE AN ACADEMIC REFEREE) WHO MAY BE
CONTACTED BY DIT IN SUPPORT OF YOUR APPLICATION

NAME                                                                  INSTITUTION
ADDRESS
                                                                      POSITION
TELEPHONE                                                             FAX
E-MAIL ADDRESS


NAME                                                                  INSTITUTION
ADDRESS
                                                                      POSITION
TELEPHONE                                                             FAX
E-MAIL ADDRESS


I confirm that the particulars given in this application are in all respects true.

SIGNATURE OF APPLICANT            ______________________________________________________________________

DATE                              ______________________________________________________________________

DIT is an equal opportunities educator, and will make no distinction between applicants where such distinction is based on
the grounds laid out in the Equal Status Act, 2000.

The Dublin Institute of Technology is a Data Controller under the Data Protection Acts 1988 and 2003.                 ep2319

				
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