MARINO INSTITUTE OF EDUCATION

PROFESSIONAL DIPLOMA IN EDUCATION (FURTHER EDUCATION)

APPLICATION FORM

SECTION A: PERSONAL DETAILS

  1. CUSTOMARY NAME (TO BE USED ON OFFICIAL COLLEGE RECORDS)

SURNAME: ______

FORENAME: ______

  1. NAME AS ON BIRTH CERTIFICATE (IF DIFFERENT)

SURNAME: ______

FORENAME: ______

  1. PERMANENT ADDRESS (TO WHICH COURSE DETAILS AND ANNUAL RESULTS WILL BE SENT)

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  1. TERM TIME ADDRESS (IF DIFFERENT)

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  1. TELEPHONE NUMBERS

LANDLINE: ______

MOBILE: ______

  1. E-MAIL ADDRESS: ______

(If your address or other contact details change, please inform us immediately in writing)

  1. DATE OF BIRTH:______PLACE OF BIRTH: ______
  1. COUNTRY OF BIRTH: ______NATIONALITY:______
  1. GENDER: ______10.PPS NO: ______

SECTION B: EU-NON EU STATUS[i] (SEE ENDNOTE)

  1. PLEASE INDICATE BELOW THE COUNTRIES IN WHICH YOU WERE ORDINARILY RESIDENT FOR THE FIVE YEARS PRECEDING THE DATE OF THIS APPLICATION

COUNTRY: ______FROM ______TO ______

COUNTRY: ______FROM ______TO ______

COUNTRY: ______FROM ______TO ______

COUNTRY: ______FROM ______TO ______

SECTION C: EDUCATION

Third Level Education (Higher Education / Further Education) details

Certificates Awarded / Institution(name and address) / Main Subjects / Year of Award
Title of Award:
Level of Award:
Diplomas Awarded / Institution(name and address) / Main Subjects / Year of Award
Title of Award:
Level of Award:
Degrees Awarded / Institution(name and address) / Main Subjects / Year of Award
Title of Award:
Level of Award:
Post Graduate Degrees Awarded / Institution(name and address) / Main Subjects / Year of Award
Title of Award:
Level of Award:

Computer Literacy

Basic Beginner / Intermediate / Advanced

ENGLISH LANGUAGE PROFICIENCY (If applicable)

If English is not your first language, please provide evidence of your English language competence. Please give details of any English language tests you have done and submit a copy of the certificate with your application.

EXAMINATION / GRADE
TOEFL
CAMBRIDGE PROFICIENCY
CAMBRIDGE ADVANCED
IELTS
OTHER

SECTION D: EMPLOYMENT

Give details in chronological order of relevant work experience starting with the most recent

JOB TITLE / Outline your responsibilities and the skills you used and/or the experience gained in this position
NAME AND ADDRESS OF COMPANY/ORGANISATION
DATES: FROM TO
JOB TITLE / Outline your responsibilities and the skills you used and/or the experience gained in this position
NAME AND ADDRESS OF COMPANY/ORGANISATION
DATES: FROM TO
JOB TITLE / Outline your responsibilities and the skills you used and/or the experience gained in this position
NAME AND ADDRESS OF COMPANY/ORGANISATION
DATES: FROM TO

SECTION E: ACTIVITIES OTHER THAN EDUCATION OR EMPLOYMENT

Give details in chronological order of any voluntary /unpaid work you have carried out.

TITLE / Outline your involvement and how you benefited from the experience
NAME AND ADDRESS OF ORGANISATION
DATES: FROM TO
TITLE / Outline your involvement and how you benefited from the experience
NAME AND ADDRESS OF ORGANISATION
DATES: FROM TO
TITLE / Outline your involvement and how you benefited from the experience
NAME AND ADDRESS OF ORGANISATION
DATES: FROM TO

HOBBIES OR INTERESTS

TYPE OF HOBBY/INTEREST / IN THE SPACE BELOW OUTLINE THE SKILLS USED AND/OR KNOWLEDGE OR EXPERIENCE GAINED FROM YOUR HOBBIES/INTERESTS

COURSE OPTION

Please indicate, by placing an X in the box, which of the two course options you are applying for:

Option 1.

Two year programme

Option 2.

One year programme:

SECTION F: PROFESSIONAL DIPLOMA IN EDUCATION (FURTHER EDUCATION)

Why do you wish to obtain a place on this programme?

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What aspects of the programme interest you most?

______

______

______

______

______

______

______

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______

Explain how your life experience and/or educational experience as outlined in Section B, C and D above are relevant to this programme.

______

______

______

______

______

______

______

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Use the space below for any additional information you wish to include.

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______

______

______

______

______

______

______

______

______

______

Please give the names and contact details of referees we can contact in determining your suitability for this programme.

Name / Name / Name
Position / Position / Position
Address / Address / Address
Telephone / Telephone / Telephone
E-mail / E-mail / E-mail

I certify that the information given above is correct and I understand that any misrepresentation may render my application void. I hereby undertake, if admitted as a student member of Marino Institute of Education, to observe and comply with all the regulations of the Institute, including undergoing Garda vetting.

Signed: ______

Date: ______

Application Fee.

There is an administration fee of €30 for each application.

You are asked to pay this fee onlineusing Easy Payments Plus via option S1-Masters, F.E. and other Application Fee), or directly to our Finance Office, phone 8535131 / 5132.

For your application to Marino Institute of Education to be complete, you must submit the following documents with your application:

□Completed application form

□Recent photograph

□Certified true copy of academic transcripts of all third-level qualifications awarded

□Copies of certificates of education achievements (where relevant)*

□A certificate of proficiency of fluency in English (if English is not your first language)

*Copies of original documents should be witnessed, stamped and signed by a Peace Commissioner or a Solicitor.

Forward all of the documentation aboveto:

Admissions Officer

Registrar office

Marino Institute of Education,

Griffith Avenue,

Dublin 9

Certificate of posting:

Claims that any application form, or letter relating to it, has been lost or delayed in the post will not be considered unless a certificate of posting from a Post Office is produced in support of such claims. The certificate may take the form of either Registration, or a Certificate of Posting obtained at the time of posting. An application by fax will not be accepted.

Further information can be obtained by phone 018057782 or email or or

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[i]European Union fees are based on residency and a European Union passport or citizenship does not grant automatic entitlement to EU fees. As approved by Board on 3 December 2003, applications for admission are classified as EU applications or non-EU applications. An EU application is one made by a person who fulfils one or more of the following criteria:

  1. who is ordinarily resident in the EU and who has received full-time further or higher education in the EU for three of the five years immediately preceding admission; or
  2. who is ordinarily resident in the EU and has worked full-time in the EU for three of the five years immediately preceding admission; or
  3. who holds a passport from an EU state and has received full-time further or higher education in the EU for three of the five years immediately preceding admission; or

Applications from children of:

  1. EU Government officials living abroad,
  2. semi-state officials who are on assignment in countries outside the EU,
  3. volunteer development workers, and
  4. certain EU officials as approved by the Department of Foreign Affairs

All other applications are considered to be non-EU applications

Non-EU Applications:

Students who have had periods of residence outside the EU are required to provide documentary evidence for their claim for EU fee status. This evidence must be presented with their application.

The admissions office may contact some applicants in order to seek supporting documentation regarding their status.