( * question MUST be answered )
 Details of Higher Education (Please indicate your primary degree and other
 degrees/qualifications which form the basis of your consideration for this programme).
 
 * Undergraduate Degree Title: 
                 English Translation (if applicable):
 * Level/Class of Award: 
                               If Other Please Specify:
 * Name of Institution Attended: 
                               If Other Please Specify:
 * Address of Institution Attended: 
 * Country of Institution Attended:
 * Period of Attendance:  From (yyyy):    To (yyyy): 
 * Main Subjects Studied:   
 * Have you completed the programme:  Yes No
 If No, Date Final Results will be available: /  mm/yyyy
 Additional relevant qualifications (Give details of other relevant qualifications attained)
 Title of other Degree/Qualification: 
          English Translation (if applicable):
 Level/Class of Award: 
                        If Other Please Specify:
 Name of Institution Attended: 
                        If Other Please Specify:
 Address of Institution Attended: 
 Country of Institution Attended: 
 Period of Attendance:  From (yyyy):    To (yyyy): 
 Main Subjects Studied: 
 Have you completed the programme:  Yes No
 If No, Date Final Results will be available: /  mm/yyyy
 

 Title of other Degree/Qualification: 
         English Translation (if applicable):
 Level/Class of Award: 
                       If Other Please Specify:
 Name of Institution Attended: 
                       If Other Please Specify:
 Address of Institution Attended: 
 Country of Institution Attended: 
 Period of Attendance:  From (yyyy):    To (yyyy): 
 Main Subjects Studied: 
 Have you completed the programme:  Yes No
 If No, Date Final Results will be available: /  mm/yyyy
 

 Title of other Degree/Qualification: 
          English Translation (if applicable):
 Level/Class of Award: 
                       If Other Please Specify:
 Name of Institution Attended: 
                       If Other Please Specify:
 Address of Institution Attended: 
 Country of Institution Attended: 
 Period of Attendance:  From (yyyy):    To (yyyy): 
 Main Subjects Studied: 
 Have you completed the programme:  Yes No
 If No, Date Final Results will be available: /  mm/yyyy
 Professional/Industrial Experience
 (Give details of most recent relevant professional and/or industrial business experience.
  Details of other experience can be sent separately):
 


 Period of Employment:
 Position Held:
 Nature of Duties:
 Name of Employer:
 Address of Employer:
 
 English Language Competency (for non-native speakers of the English language only): 

 Examining Body:
 Date of Completion: / /  dd/mm/yyyy
 Score:
 
 Publications: 
 List publications with date, subject and journal title. Use additional sheet if necessary, indicating your PAC Application
 number at the top of each sheet, and post to Postgraduate Applications Centre, 1 Courthouse Square, Galway, Ireland.
 
   Date  Subject    Journal Title
  /  mm/yyyy   
  /  mm/yyyy   
  /  mm/yyyy   
 
 * References: 
 Non-UCC applicants must provide the names of two referees (at least one should be an academic referee).
 Please ensure references are forwarded to the Postgraduate Applications Centre, 1 Courthouse Square,
 Galway, IRELAND. Your PAC application number should be clearly indicated on the references.
 Name:  
 Address:  
 Institution:  
 Position:  
 Phone No.:  
 Email:  
 
 Name:  
 Address:  
 Institution:  
 Position:  
 Phone No.:  
 Email:  
 IMPORTANT NOTE
 Candidates applying to research programmes in Arts, Law, Commerce or Medicine & Health are required to submit a  research proposal (1500 words approx. and 500 words in the case of Commerce applications).
 Note: a research proposal is not required in the case of the PhD in BIS CKN18, DSocSc - CKH71 or DClinDent  Orthodontics CKZ62).
 Research proposals can be submitted by uploading them via the 'My Account' link.


 EU fees status:
 I confirm that I have verified my EU fees status for the purpose of postgraduate study at University College Cork
 and will provide the necessary evidence (eg passport/birth certificate and copies of appropriate tax residence forms)
 on request    
 
 Where did you first hear about the programme/s you are applying for ? * : 
Academic Staff Advertisement Postgraduate Fair/Exhibition (International)
Postgraduate Fair/Exhibition (Ireland) UCC Information Session UCC Postgraduate Open Day
UCC Online Postgraduate Prospectus Other Internet Sites Press Article Word of Mouth
Your Careers Service Other
 
 If Advertisement/Careers Fair/Exhibition/Other internet sites/Other
 Please Specify:
 
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