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Cork Institute of Technology

BA in Community Development – CR_HCOED7
• Please complete each section of the form. You may
useseparate sheets if you wish to provide additional
information for any section.

• To be filled in BLOCK LETTERS

Please return completed application form to:

Anne Deasy

DEIS Department, School of Humanities

Cork Institute of Technology

Bishopstown

Cork

Tel: +353 21 433 5930

An acknowledgement of your application will be issued upon receipt by the Department.

Please check with the Department for application dates.

FT_Academic Year 2012/2013- 1 -

SECTION A

PERSONAL DETAILS:

Name
Address
Telephone
Date of birth
Nationality (as per passport)
Non EU Applicants only: Please indicate your status below
I will be applying for a study visa. I will be paying non EU fees.
I already live in Ireland. Type of visa held:
I have refugee status. An applicant with Refugee status should attach a copy of Stamp 4
Permanent address
Telephone number
Email

How did you hear about this course? ______

Ifyouwishyoumaymentionanyconditionofhealthordisabilitywhichcouldhave a bearingonyour studiesorwhichrequirestheprovisionofspecialfacilities.Youmayuseadditionalsheetsifnecessary.

______

SECTION B

EXPERIENCE IN COMMUNITY WORK:

(i) Please indicate your experience in this area to date which you consider may be appropriate in assessing the merits of your application for this course. Youmayuseadditionalsheetsif necessary.

DATES / EXACT TITLEOF YOUR POST
from / to
Brief outline of duties:
FULL NAMEANDADDRESS OF ORGANISATION
DATES DATES / EXACT TITLEOF YOUR POST
from / to
Brief outline of duties:
FULL NAMEANDADDRESS OF ORGANISATION

(ii) Other Work Experience:

DATES / EXACT TITLEOF YOUR POST
from / to
Nature of Work:
FULL NAMEANDADDRESSOFEMPLOYER
DATES / EXACT TITLE OF YOUR POST
from / to
Nature of Work:
FULL NAMEANDADDRESSOFEMPLOYER

SECTION C

EDUCATION:

SECOND LEVEL EDUCATION:

Name(s)andAddress(es)ofSchoolsattended / Years ofstudy
from / to
LeavingCertificateor
final examinationstaken / Examination
Dates / Subjects
Passed / Level / Result/
GradeorMark

THIRDLEVELEDUCATION: Please tick yes ___ or no ____

If yes, please provide further details:

NamesandAddressesof
Institutionsattended / Yearsof study / Qualification
from / to

ENGLISH LANGUAGE QUALIFICATION:

If English is NOTyour first language, this section must be completed. Please specify which English language qualification you have, or intent to take, and give the relevant grade source for all components. Please attach supporting documentation.

Qualification / Grades/Scores / Date of Qualification:
IELTS
TOEFL paper-based
TOEFL computer based
Other: please specify

SECTION D

SUPPORTING STATEMENT:
(Please use this space to include information which you may consider pertinent to your application, eg. Nature of community experience, reasons for applying for this course. You may also attach additional pages(s) as necessary.

______

SECTION E

REFERENCES:
(Please give names and address of two persons, not related to you, whom the Institute may approach for references).

Name
Address
Institute
Position
Email
Telephone
Name
Address
Institute
Position
Email
Telephone

DECLARATION

I understand that completing this application form is not to be construed as imposing
a legal obligation on the Institute to supply courses or modules in respect of the
Community Development programme of study.

I declare that the information provided in this application and other documentation
supplied herewith as part of this application is complete and accurate.

I hereby give my consent to the Institute to make enquiries to all referenced institutions/bodies/persons to satisfy itself that the information I have supplied in
this application is true and correct.

I understand that any incorrect information or significant omission will be grounds
for forfeiture of a place.

Signature of Applicant______

Date______

BA in Community Development

Further Information for Applicants

  1. You will be required to attend a suitability test/interview and/or submit a portfolio as part of the admissions requirement.Iinterview dates have been scheduled by the Department. Please check with the Department for exact dates by telephone, Ms. Anne Deasy, 021 – 433 5930.
  1. All foreign applicants will be required to satisfy all the normal legal requirements as laid down by the Department of Justice, Equality and Law Reform and the Department of Foreign Affairs to gain access to this Programme of Study.
  1. The Institute reserves the right to request certified true copies of transcripts of examinations results from each Secondary School or High School and also from each third level college or University that you have attended, with English translations, if appropriate, as detailed on your application.
  1. If your first language is not English, it will be necessary to provide evidence of proficiency in English, for instance TOFEL (paper based 550, computer based 213) or IELTS (Level 6.0) or Cambridge (Advanced Level).
  1. This programme requires applicants to undergo a Garda Vetting process. This requirement is due to the mandatory external placement element of the programme which will bring the applicant into contact with children or vulnerable adults and in which they will assume positions of trust. CIT uses the Garda Central Vetting Unit to help assess the suitability of applicants on this programme. Offers of a place of this programme will be provisional and contingent on the applicant’s satisfactory completion of CIT’s Garda Vetting Procedure.
    Please refer to
  1. Your registration will be subject to the payment of any fees due of which you will be notified by the Fees Office of the Institute.

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