COLÁISTE na hOLLSCOILE, CORCAIGH - OLLSCOIL na hÉIREANN, CORCAIGH
UNIVERSITY COLLEGE, CORK - NATIONAL UNIVERSITY OF IRELAND, CORK
TELEPHONE NO. (021)4903571;E-MAIL:
APPLICATION FORM FOR ADMISSION TO THE
BSC (NURSING STUDIES) DEGREE PROGRAMME 2018/2019
SURNAME:______
FORENAME: ______
TITLE:
(e.g Ms, Mr, Rev, etc)
DATE OF BIRTH:______PPS NUMBER: ______
COUNTRY OF BIRTH:______NATIONALITY: ______
ADDRESS FOR______
CORRESPONDENCE:
______
______
______
(Please notify all changes of address immediately)
TELEPHONE NO.:______MOBILE NO.: ______
EMAIL ADDRESS: ______
PERMANENT HOME ADDRESS ______
(if different from above)
______
______
______
EMAIL ADDRESS (mandatory) ______
AN BORD ALTRANAIS PIN NO ______
Are you applying for the BSc Nursing Studies: Full Time OR Part Time Full time: over one academic year (60 credits)
Part time: over two academic years (30 credits per year)
1.(a)Have you previously applied for admission to this University?
1. Yes 2. No
(b)If so, state year of application and course:
Year: ______Course: ______Student Number: ______
- Do you hold:
YESNO
(a)A Certificate in Nursing?
(Pre-registration of 3 years duration)
(b)A Diploma in Nursing?
(Pre-registration of 3 years duration)
(c) A Higher Diploma in Midwifery
If YES to any of the above, in which University/College
was this completed (including date) ______
(d)Do you hold any other academic qualification(less than 5 years old) which you feel would entitle you to academic exemptions e.g. Continuous Professional Development (CPD) Module see /
FOR ALL OF THE ABOVE (A – D) PLEASE GIVE DETAILS AND ENCLOSE RELEVANT DOCUMENTATION.
3.Nursing Education
Qualification / Institution / From - To(Specify Dates) / Award & Date
4.Nursing Experience since Registration (Starting with most recent experience; may be continued on a separate sheet)
Name and Address ofHospital or Employing
Authority / Position Held
(Grade and current position) / Type of Experience
e.g. Acute, medical,
elderly, paediatrics,
midwifery,
PublicHealth, etc. / From-To
Give month
and year / No. of
Months/
Years
5.Studies (general or professional) undertaken within the last five years
Title of Course / Institution / From - To / Mode of AssessmentExam/Course Work / Award & Date
I acknowledge that the particulars given on this form are in all respects true.
Date: ……………………………Signature: ……………………………………………….
BSC (NURSING STUDIES)
Asigned statement (see below)of approximately 200 words, in answer to the following question:
Why do you feel that you should be accepted on the BSc (Nursing Studies) Programme?
I declare that the content of this statement is all my own work.
Signed ______Date ______
Final Checklist.
Have you included:
- Supplementary answer sheet which accompanies the official application form
- Original or *certified true copy of Leaving Certificate or equivalent (for record purposes)
- Original or certified true copy of English Language Competency Certificate for applicants whose first language is not English (see attached English Language Requirements)
- Official confirmation of your nursing qualifications (both general and midwifery, also if appropriate Public Health) from the relevant Health Board or Hospital
- Evidence of current registration with the Nursing and Midwifery Board of Ireland
- Original or Certified true copies of Birth Certificate and Marriage Certificate (if applicable)
- Two passport size photographs
- €35 Application Fee (non-refundable). Application Fee payment should be made by Cheque, Postal Order etc. andmade payable to University College Cork.
- Other information which you feel might support this application.
*A certified photocopy is a copy that has been signed and stamped by an authorised person such as a Garda.
Have you filled in your name and address on the acknowledgement card?
Please forward the completed application form to:
The Admissions Office,
West Wing, Main Quad,
University College,
Cork.
CLOSING DATE:Friday 4th May, 2018.
SUPPLEMENTARY ANSWER SHEET