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: ______

  1. 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 of
Hospital 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 Assessment
Exam/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