The O Reilly Foundation

THE O’REILLY FOUNDATION

Scholarship Programme

Application for Scholarship 2008/2009

Please complete this form and return by email, to be received by Friday 7th November 2008. Please ensure that Academic Transcripts andcopy of Letter of Acceptance from institution (if confirmed) are also sent to be received by the same timing. The two Referee’s Report Forms (enclosed) should also be returned, directly by Referees, by email, to the Foundationby this date.

PART 1: PERSONAL DETAILS

FULL NAME:

Family name / First name / Middle initials

HOME ADDRESS: ADDRESS FOR CORRESPONDENCE

(If different)

TEL. NO:…………………………………….E-MAIL:………………………………………….

NATIONALITY:…………………….… Country of Legal Residence:…………………………..

PLACE OF BIRTH:…………………………….DATE OF BIRTH:………………………………

AGE:………………….………..

PART 2: PROPOSED ACTIVITY

Title of Proposed Activity
Field of Study (e.g. business studies; law; engineering; marketing; media studies; arts; etc)

PART 2: PROPOSED ACTIVITY (Contd)

STATEMENT OF PROPOSED ACTIVITY

Describe in not more than one page below your proposed research topic and programme, and its potential for or relevance to Ireland.
If institutional acceptance has been confirmed, please name the Institution and the Department and Professor with whom you will work, and enclose a copy of the letter of acceptance.
If institutional acceptance has not been confirmed, list preferred institutions in order of priority, including Departments and Professors, if known.

PART 3:ACADEMIC AND EMPLOYMENT DETAILS

COLLEGES, UNIVERSITIES, PROFESSIONALSCHOOLS ATTENDED (most recent first).
Official transcripts and/or academic records from all third-level institutions attended should be forwarded by the closing date.
InstitutionDatesDiscipline/FieldQualification/Grade
Details of all previous or current scholarships, awards or grants, both academic and professional (including dates)
EMPLOYMENT HISTORY
Details of any previous or current employment (most recent first)
DateEmployerRole
How do you envisage developing your career over the next ten years?

PART 4: PERSONAL INTERESTS AND ACHIEVEMENTS

Describe your particular interests, abilities and extra-curricular activities, including any offices held, specific achievements, awards obtained, etc.
Describe an example of a situation or event where you felt that you achieved something worthwhile. Please give as much detail as possible e.g. What happened? What did you do? Who else was involved? How did you feel at the time?

PART 4:PERSONAL INTERESTS AND ACHIEVEMENTS contd

Describe a different situation or event where you had to overcome challenges or obstacles in order to achieve something you felt was worthwhile. Please describe in detail as before e.g. What happened? What did you do? Who else was involved? How did you feel at the time?
How would you expect to make a contribution to the economic, social or cultural development of Ireland?
Is there any additional information relevant to your application that you would like to include?

PART 5: REFEREES

Name your two referees and their contact details, including their working/business addresses. Referee’s Report Forms, enclosed, should be sent to referees for their completion and return.

______

N.B.: Applicants must be available to attend an interview in Dublinon the

8th December 2008 to be considered for an O’Reilly Scholarship.

Completed applications and referee’s reports should be returned by email to:

Tel/Fax No: 01 2946550

Please keep materials being emailed to a reasonable size (under 1MB preferred)

Closing date for receipt of applications is 5.30 p.m. Irish Time on Friday 7th November 2008.

I certify that the information given in this application is complete and accurate, to the best of my knowledge.

Signature/Name: Date:

REFEREE'S REPORT (1/2)

Please complete and return directly by email to: (tel./fax: +353 (0)1 294 6550), to arrive before 5.30 p.m. Irish time, Friday 7th November, 2008.

Applications cannot be reviewed without referees' reports.

PART 1 (to be completed by applicant)

Name of Applicant:
Department:
Institution:
City/Country:
Name of Referee:
Department:
Institution:
City/Country:

PART 2 (to be completed by referee)

Please give your opinion of the applicant's academic/ professional qualifications, character, adaptability, the significance and feasibility of their proposal and the potential contribution to Ireland's future development.

Referee's signature / name:Date:

REFEREE'S REPORT (2/2)

Please complete and return directly by email to: (tel./fax: +353 (0)1 294 6550), to arrive before 5.30 p.m. Irish time, Friday 7th November, 2008.

Applications cannot be reviewed without referees' reports.

PART 1 (to be completed by applicant)

Name of Applicant:
Department:
Institution:
City/Country:
Name of Referee:
Department:
Institution:
City/Country: