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APPLICATION FOR SOCRATES GRANT

Students on the University’s programmes in ALIS, LIC, IBL, EB, IR, EPL, MIJS and Engineering programmes, travelling to foreign universities with which we have an Erasmus bilateral agreement must complete this form.

All information provided in this form, and all correspondence in connection with the application, will be treated in strict confidence, and will not form part of the University’s general student records.

This completed form, should be returned in an envelope to the INTERNATIONAL OFFICE, marked ‘Confidential: SOCRATES Grants’, to arrive not later than the 27^th May 2011

This form has been designed to assist us in identifying those in greatest need. It is in your own interest to complete the form as fully as possible. Supplementary information may be attached on a separate sheet, but not as a substitute to completing the form.

The giving of false information on this form will render the application invalid, and may be referred to the Disciplinary Committee.

Name of Applicant: ________________________________ Age: __________________

Student Number: _______________________________ Degree Course: _____________

Host University: __________________________________________________________

Full Postal address[1]: _______________________________________________________

________________________________________________________________________

Are you eligible for a Higher Education Grant, VEC Scholarship, or other such award? If not, state the reasons. If you are in receipt of such an award, or of a DAAD Scholarship or similar form of support, please give full details:

________________________________________________________________________

Please give details of any work placement or assistantship (or ‘stage’) which is part of your period abroad:

________________________________________________________________________

Please give details of any remission of fees or other forms of support you have received from this University either in the past or in the current academic year, or any application for same which is still being considered or which you intend to make:

________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please give the details of any loans from banks etc. which you have taken out:

________________________________________________________________________

Gross Parental Income (Please note this must be given by all applicants under 26):

_____________________

Number of dependant children in family: _____________________

Please give all additional relevant details regarding your financial situation, including the amount of money you currently have or expect to receive in the near future, and foreseeable expenses associated with the year abroad other than the usual living and travel expenses:

________________________________________________________________________

Please give the names and addresses of two referees and indicate their status (i.e. why they are in a position to act as your referee).

These should not be members of your family, but should be persons resident in Ireland who are aware of your circumstances and who can therefore provide independent corroboration of the information given by you. You should tell your referees that their names are being used.

________________________________________________________________________

Bank Account Details:

Bank Type and Branch …………………………………………………….

Name of Account Holder ………………………………………………….

Bank Account Number: ………………………………………

Bank Sort Code ………………………………………………

Account type (savings, deposit, etc) …………………………………….

Bank IBAN code: ……………………………………………………….

Bank BIC code: …………………………………………………………

I certify that the information given on this form is correct.

Signed: __________________________ Date: _______________________________

PLEASE RETURN TO THE ERASMUS CO-ORDINATOR IN THE INTERNATIONAL OFFICE BEFORE May 27^th 2011

[1] For correspondence during the months prior to departure.

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APPLICATION FOR SOCRATES GRANT

PLEASE RETURN TO THE ERASMUS CO-ORDINATOR IN THE INTERNATIONAL OFFICE BEFORE May 27th 2011

PLEASE RETURN TO THE ERASMUS CO-ORDINATOR IN THE INTERNATIONAL OFFICE BEFORE May 27^th 2011