Institute of Technology

Blanchardstown

FULL TIME POSTGRADUATE PROGRAMMES

APPLICATION FORM

Completion of an application form should not be viewed as the basis of a contract between applicants and
the Institute. The Institute reserves the right to amend courses, fees and regulations at any time.

If you have ever been registered as a student in ITB, please quote your student ID Number:

If you have ever been a student in any other 3rd level Institute, please quote your student ID Number:

Institute Name:

1. PERSONAL DETAILS (BLOCK CAPITAL LETTERS)

SURNAME .................................................................................................................................................................

OTHER NAME (S) .....................................................................................................................................................

(The names given above will appear on all Institute documentation, including parchments etc.)

TEL. No. (Home) ...................................…..…. (Work) .....…...............................................................................

MOBILE No. .................................................... E-MAIL ......................................................................................
PERSONAL PUBLIC SERVICE (PPS) NUMBER (formerly RSI No) ...................................................................
HOME ADDRESS (all Institute correspondence will be posted to this address) ...............................................................
.......................................................................................................................................................................................
TERM ADDRESS …………………………………………………………………………..………………………
.......................................................................................................................................................................................
Male Date of Birth Country of Birth Nationality
Female

2. PLEASE INDICATE THE POSTGRADUATE PROGRAMME COURSE FOR WHICH

APPLICATION IS BEING MADE
Master of Business BN525
Master of Science in Computing (Information Security & Digital Forensics) BN518
Higher Diploma in Science in Computing BN509
Master of Science in Technology Entrepreneurship BN523

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3. THIRD LEVEL EDUCATION (please start with the most recent institution attended)

(a) Course(s) Attended. You must enter all third level education that you are attending/have attended (e.g. Institute
of Technology, University, Private College or other Third Level College)

Names & Address of College/Institute From To

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(b) Examinations taken / to be taken

External students applying should ensure to submit a copy of your examination results with your application or as soon as
they become available if undertaking exams during the current year. No decision will be made by the Admissions Committee
until these results are sent in by you.

Examining Body e.g. Course Title Grade Point Average or overall Year
HETAC, BTEC, NUI e.g. Higher Certificate in …... Percentage Mark Achieved Conferred

(c) Please list subjects taken in Award Year

Module taken Credits Results (specify grades)

4. EMPLOYMENT DETAILS (please start with the most recent employment)

Please use additional sheet(s) if required. Documentary evidence of work experience must accompany this application
form.

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 Dates
Name of Organisation (s) Job Title From To

5. MEMBERSHIP OF PROFESSIONAL ASSOCIATIONS, INSTITUTIONS, ETC

Professional Association Period of Membership Grade of Membership

6. OTHER INFORMATION TO SUPPORT YOUR APPLICATION

Please outline why you feel a full time postgraduate programme will benefit you at this time. Explain your career
goals and how the successful completion of your chosen programme relates to those goals.

7. REFEREES

Please give the name and address of two referees (one academic and one work-based where possible).

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8. QUALIFICATIONS RECOGNITION

Applicants who have obtained a qualification outside the Republic of Ireland or the UK, are requested to obtain a
letter from Qualifications Recognition (www.qualrec.ie) comparing their foreign qualification with an Irish
qualification.
Qualifications Recognition is the Irish centre that provides an information service that helps individuals compare their
foreign qualifications with Irish qualifications on the Irish National Framework of Qualifications (www.nfq.ie).
The Institute regards this information as extremely important to verify the level of your award thus facilitate a
determination on your eligibility for the course for which you have applied.
The qualification recognition service is free of charge, however assessment of a qualification may take a few weeks
so it is advisable to apply at least 3 months before the start of the course. Qualification Recognition can be contacted
on 01 8871500 or www.qualrec.ie

9. DECLARATION

I declare that the information given by me in this application is true, complete and accurate and that if I am admitted
as a student I will inform myself of, and abide by the Regulations of the Institute of Technology Blanchardstown.
(Copy available on request)

Signed Date

10. PAYMENT OF FEES

Course fees are payable in advance in order to secure your place. Payment can be made by cheque or postal order
only. Cheques should be crossed and made payable to the Institute of Technology Blanchardstown.

11. SUBMISSION OF APPLICATION

• The closing date for applying for all full-time post graduate courses is Thursday, 1st September 2011
• Please submit this form once fully completed to
Admissions Office
Institute of Technology Blanchardstown
Blanchardstown Road North
Dublin 15
• Please ensure that you have attached all relevant documentation
• Courses will only commence if sufficient numbers of qualified applicants apply