Independent Colleges - Application Form

Degree Application Form

Personal Details

Gender:	Title:

Surname (as on birth certificate):

Other Names in Full (as on birth certificate):

Date of Birth (dd/mm/yyyy):

Nationality:

Address for correspondence:

Telephone Number:

Mobile Number:

E-mail Address:

Emergency Contact:

Do you have a disability or any special needs?

Details:

Where did you hear about us?

Employment Details
Employer Address:

Telephone Number:

Education Details
Name of School/College/University:

Degree Qualification:

Awarding Body:

Years of attendance:

Leaving Cert Completed:

Yes
No

Other qualifications completed (A-Levels etc):

Application for Advanced Entry
Do you wish to apply for exemptions:

Yes
No

(if yes please forward a photocopy the relevant official examinations results and a full course syllabus to this application) What exemptions do you wish to be considered for?

Study Mode

Full Time
Evening Time

Programme Applying for:

MA Journalism
BA Journalism
MA in Psychoanalytic Psychotherapy
BA in Psychotherapeutic Studies
H.Dip in Psychotherapeutic Studies
LLB in Irish Law
MAcc in Accounting
MSc in Computer Security and Forensics

Please note for the MA in Psychoanalytic Psychotherapy and BA in Psychotherapeutic Studies, applicants must be over 23 years of age by the 1st of January of the year of application.

Declaration
I hereby confirm that the information given above is correct and I undertake to comply with all regulations of Independent Colleges. I understand that Independent Colleges maintains the right to change any of the details given in any course brochure and that courses are offered subject to student demand. Course fees will not be refunded once a course has commenced.
The college reserves the right to apply to the Garda Central Vetting Unit with a request to vet all prospective students on our Psychotherapy programmes. By signing below you agree that the college is free to make such an application in your case and that any problem arising from that enquiry may result in your being removed from the course at a later date.
Full Name:

Date (dd/mm/yyyy):

*Do you have legal entitlement to remain in the country to complete the proposed course of study without the requirement of a study visa?

Yes
No

If English is not your first language please consult the College prospectus for the English language requirement associated with your chosen course.