* Have you discussed the proposed Research topic with a Supervisor from the relevant School? Yes No    
If no, you will not be able to proceed with your application.
   Please refer to the DCU website to arrange to discuss your Research topic.   
 
   * question MUST be answered
 
 * Name (as you wish it to appear on all official University records):
Surname:
First Names:
Title:
 
 * Name as on Birth Certificate:
 Surname:
 First Names:
 
 * Date of Birth:  /   / 
 
 * Gender:  Male Female
 
 * Medical Condition/Disability:  Yes No
 
 * Home Address: Rep. of Ireland Other Country
 
 
 
 
 
 * Correspondence Address: If SAME as above, please tick here   
  Rep. of Ireland Other Country
 
 
 
 
 
 * Main Contact Number:
 Mobile Telephone:
 Work Telephone:
 
 (Enter International Agent's details if applicable)
 International Agent's name:
 International Agent's e-mail address:
 Confirm International Agent's e-mail:
 
 * Country of Nationality:
 * Country of Birth:
 
 * Most recent Educational Institution Attended:   
 
 * Applicant's Current Status: 
Current DCU Student
DCU Graduate
Other Applicant
 

 * Have you ever previously registered with DCU?:
Yes No
 DCU Student Number
(if applicable):  		 

 If you have an additional DCU Student Number, please click here
 

 Important note for sponsored applicants
  • If you are an approved Irish Aid Fellowship applicant and have a sponsor code from ICOS
  • or have a sponsor code from International Office in DCU
  • or are a Brazilian student under the `Science without Borders` funding scheme
      Please enter code:  
      ICOS/DCU will arrange payment of the application fee on your behalf
 
 RESEARCH PROPOSAL

 Course choices
 
 To lookup course codes, click here
 
 Programme Code
Proposed Start Date /  mm/yyyy
 
 Proposed Title: 
 Summary of Proposed Research (200 words max): 
 Select School:
 Select Primary/Secondary Supervisor name(s):

 If Other Supervisor, please specify:
 
 Have you received Scholarship Funding for this programme?   Yes  No
 Funding Type:
 If Other Funding, please specify:
 
 Is research to be conducted by Distance Mode or Remotely?  Yes  No
 Details of Host institution/company: 
 Proposed Supervisor of Host institution/company: 
 
 Please indicate if it will be necessary for you to reside and/or undertake research outside of Ireland for six months or more?  Yes  No
 If yes, please give details: 
 

 
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