STAPLE SUPPORTING DOCUMENTS TO THE LAST PAGE CONFIDENTIAL UNIVERSITY

Staple supporting

documents to the

last page

CONFIDENTIAL

University College Dublin

UNDERGRAD Occasional student Application

Affix a current Passport-size photo in this area

ACADEMIC YEAR 2007 / 2008

Personal Details

1. Surname________________________________________________________

2. First Names_____________________________________________________

3. Permanent Home Postal Address________________________________________________________

_________________________________________Telephone_____________

Mailing Address, if other than above________________________________

_________________________________________Telephone_____________

e – mail address _________________________________________________

4.	Date of Birth			Sex	Nationality	Place of Birth
	Day	Month	Year

Education

5. Education/Qualifications to date. Ensure Addresses are up to date. Please attach certified documents with your application

Name and address of Institution	Qualification and course	Year commenced	Full or part-time	Results to Date	Years Completed

6. Which university / business school are you currently registered at? __________________________________________________________________________________________________________________________________________

Employment and work Experience (if applicable)

7. Present job title__________________________________________________

Employer______________________________________________________

Office Address__________________________________________________

______________________________________________________________ ______________________________________________________________

_________________________________Office telephone________________

8. Previous Work Experience

Employer	From/to	Position

9. How long do you wish to spend at University College Dublin?

Undergraduate

One Semester q q Semester One (September to December)

q Semester Two (January to June)

Full Year q

10. Reason for coming to University College Dublin

_______________________________________________________________

_______________________________________________________________ _______________________________________________________________ _______________________________________________________________

_______________________________________________________________

_______________________________________________________________ _______________________________________________________________ _______________________________________________________________

References

1.Academic_______________________________________________________________________________________________________________________________________________________

2.Business/Personal________________________________________________ ________________________________________________________________________________________________

Please State where you learned about this programme

_______________________________________________________________________________________________________________________________________________________________________________________________________________

I hereby declare that the information I have provided is true to the best of my knowledge. Any deliberate misrepresentation may be grounds for refusing admission

Candidate's signature__________________________________ Date______________

Please return the completed application form with copies of all University examination results and references to the address below by 1^st May 2007 for Semester 1 and Full year applications and by 1^st November 2007 for Semester 2 applications.

Esther Sanz, Tel: +353 – 1 - 7164750

Quinn School of Business

University College Dublin

Belfield,

Dublin 4,

Ireland