Doctoral Programme inClinical Psychology Application Form
Please complete this form with reference to the notes provided’Notes for Applicants 2018’
Return 10 copies with a non-returnable application fee of €50
(online payment instructions in Notes please use the link provided).
Completed applications should be returned to:
The Course Administrator, Doctoral Programme in Clinical Psychology, Room G218 School of Psychology, Newman Building, Belfield, Dublin 4.
This application form must be returned on or before 5.00pmFriday 2ndFebruary 2018
Enquiries about the course should be addressed to the Course Administrator at
+353-1-7168120 or by e-mail at / Scan a passport size photo and insert hereor glue a passport size photo here
Personal Information
Name
Home Address
Home Phone Number / Mobile Phone Number
E-mail Address (1) / E-mail Address (2)
Age: / Date of Birth
Referee Information
Referee 1: Academic / Name and address: / Phone Number:
E-mail Address:
Referee 2: Employer / Name and address: / Phone Number:
E-mail Address:
Please ensure you have included the following with your application / √
1. / Online Application Fee– Reference and Date of Payment:
2. / 10 copies of this application form(a clear passport size photo must be included on all 10 copies)
4. / A course transcript from the universities where you obtained your academic qualifications, if you have not studied at UCD previously
5. / A photocopy of your birth certificate or passport, if you have not studied at UCD previously
6. / Your student number, if you are a past student of UCD
I declare that the information given in this application is true and accurate.
Signature of Applicant / Date

1. Sponsorship preferences – contingent on availability for the Programme 2018-2021.

Please indicate your sponsoring preferences by placing the number 1 beside your first preference, the number 2 beside your second preference, the number 3 beside your third preference (and so on). Information on sponsoring agencies is available at their website. If you are offered a place on the course, and sponsorship, you will be required to complete most of your placements in your sponsoring agency and to be available to spend 3 years after graduation working in that agency. Please also see section 1 of Notes for Applicants 2018.
Agency /

Website

/

Preference No

(1 or 2)
HSE CHO Area 8 – Longford/Westmeath /
HSE CHO Area 8 – Laois/Offaly /
HSE CHO Area 8 – Louth/Meath /
HSE CHO Area 5 - Waterford, Wexford, Carlow/Kilkenny /
Explain your sponsorship preferences in 50 words:
Alternative Funding Routes for EU and Non-EU Students :
I am an international student and have Non-EU Governmental or other Institutional funding to support my application: / Please Provide Details:
I am an international student and have self-funding to support my application / Please Provide Details:
I am an EU student and in the event traditional sponsorship is unavailable for the 2018 intake I would consider self-funding (your response will not affect your application to a traditional sponsored place). Financial support may be available through graduate student bank loans – please see notes). / Yes / No

2. Secondary Education exam results (Leaving Certificate, A level results, or equivalent)

Dates / Results
From / To / Name of school / Exams Taken / Level
H/0 / Grade / Points
1.
2.
3.
4.
5.
6.
What are your total points(or average percentage for A level). International applicants please indicate your GPA.
If English is not your first language, specify results in oral and written exams taken to evaluate competence in using the English language, i.e. TOFEL / Exam / %

3. Undergraduate university education in Psychology (BA, BSc, H Dip Psych)

Dates
From / To / Name of University / Degree / Level of Award / %
Tick the box opposite if your degree confers eligibility for graduate registration with the Psychological Society of Ireland.
Tick the box opposite to indicate that you have included a photocopy of your course transcript and a photocopy of your birth certificate or passport if you received your degree from a college other than UCD

If you have previously attended UCD please give your Student Number

4. Postgraduate university education in Psychology(MA, MSc, MPsychSc, M Phil, PhD, D Phil)

Dates
From / To / Name of University / Degree / Level of Award / %
Indicate the proportion of the programme (s) that involved coursework, placement and research / Coursework / Placement / Research
If you are undertaking a research degree such as an M Litt or PhD, when do you expect to graduate
Tick the box opposite to indicate that you have included a photocopy or your course transcript and a photocopy of your birth certificate if you received your degree from a college other than UCD

If you have previously attended UCD please give your Student Number

5. Other relevant professional training experiences (including workshops, certificates, diplomas or qualifications)

200 words max

6. Relevant research experience (including undergraduate project research experience, graduate research experience, clinical research assistant experience, computing skills & qualifications, statistics qualifications, theses, presentations, publications, & technical reports)

500 words max

7. Relevant clinical work experience. (Please see notes for applicants to correctly complete this section. List from most recent. Append additional page if necessary)

From / To / Employer’s name address / Supervisor's name, occupation, & number of hours of formal supervision per week / Post details / Responsibilities and competencies developed in post
(50 words max per post)
(50 words max)

8. Outline in no more than 300 words your reasons for applying for clinical training and any other information that you consider relevant to your application.

300 words max

1