ITT Dublin. Erasmus + Application Form 2015-2016
Closing date: 01 June 2014 for arrival in autumn 2015 or 01 November 2015 for arrival in spring 2016
General Information:
ALL sections must be completed. Incomplete forms WILL NOT be processed.
Pay particular attention to postal address and e-mail address.
If possible type this information before printing and signing the form.
YOUR FORM WILL BE TOTALLY IGNORED:
- if you send it by e-mail,
- if you post it later than the deadline,
- if it does not have the signature of your academic coordinator /
international officer, or
- if you post it without including 2 passport-type photographs.
We will issue confirmation of receipt of application forms via email only. This
confirmation will be emailed after 15 June / 15 November.
Do you require a written letter of acceptance? You must then enclose a selfaddressed envelope when you post your form. Do not include a postage stamp.
Confirmation letters will be posted after 15 June / 15 November. I regret we
cannot enter into email correspondence with students about arrival or nonarrival of application forms before this date.
Decide what you can study in Dublin
1. There are entry restrictions on some courses. Please check with your
coordinators at home whether any restrictions apply to your semester(s) in Dublin.
2. Your selection below is not guaranteed (unless specified under the terms of
your institute’s bi-lateral agreement with ITT Dublin).
3. If you expect to take modules from 2 or more Departments:
The timetables for 2015-2016 will not be available until the first day of each
semester. Therefore you can prepare only a provisional list before arrival. Your
final selection of modules must take place after arrival at ITT Dublin.
4. Module (subject) details are available online from May 2015. www.ittdublin.ie
5. To find the list of courses: First click on full time courses.
Then click on an academic Department, e.g. Humanities.
Under ‘View courses’ you can find a list of programmes, e.g. Bachelor of Arts.
Click these programmes and view how the course is divided by semester.
Click on the modules to read course descriptions.
Look at these examples, then fill your proposals on the application form :
Name of the course
Department
B.A.(Hons) European
Studies
Manufacturing
Engineering
Humanities
Mech.
Engineering
Year
Semester
Subject/module title
2
5
European Union Law
4
7
Materials Science
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6. In the autumn semester you can study modules in semester 1,3,5,7,and 9. In the
spring semester you can study modules in semesters 2,4,6,8 and 10
WE DO NOT ACCEPT APPLICATION FORMS BY E-MAIL
Return forms BY POST ONLY to:
International Office. Attn: Tara McKiernan, ITT Dublin, Tallaght, Dublin 24. Ireland
ITT Dublin. Erasmus + Application Form 2015-2016
Closing date: 01 June 2014 for arrival in autumn 2015 or 01 November 2015 for arrival in spring 2016
ERASMUS+ APPLICATION for 2015-2016 only
Only for Erasmus students already nominated by their home university
Section I: Personal Data
PLEASE USE BLOCK CAPITALS
Surname: __ __ __ __ __ __ __ __ __ __ __ __
PLEASE USE BLOCK CAPITALS
First Name: __ __ __ __ __ __ __ __ __ __ __ __
Male 
Female 
Nationality:
Native language:
_____________
Passport / Identity Number:
Date of Birth:
Circle Your Study period: Winter semester 2015
Photo
2 photos are required.
Firmly Attach photo #1 here:
Enclose photo #2 with
application. On the back of
photo #2 write:
1. your name, and
2. the semester(s)
you’ll study here.
Example: 1. Tara McKiernan
2. Full year 2015-16
Full year 2015-16
Spring 2016
USE BLOCK CAPITALS TO ENSURE YOU RECEIVE ALL CORRESPONDENCE FROM US !!
PERMANENT ADDRESS :
Telephone (including all codes)
E-mail: PLEASE write very clearly so that you will receive our emails !!!
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _
NEXT-OF-KIN - please provide details of a relative (not a friend) who will be contacted if
you are in a serious accident or other emergency.
Full name :
Telephone (include all codes):
Relationship to you:
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E-mail of your next-of-kin:
__________________________ __________________
WE DO NOT ACCEPT APPLICATION FORMS BY E-MAIL
Return forms BY POST ONLY to:
International Office. Attn: Tara McKiernan, ITT Dublin, Tallaght, Dublin 24. Ireland
ITT Dublin. Erasmus + Application Form 2015-2016
Closing date: 01 June 2014 for arrival in autumn 2015 or 01 November 2015 for arrival in spring 2016
Section II : Your studies at your home university.
Home Faculty and/or Department in which you are now studying:
___________________________________________________________________
YOUR Exchange co-ordinator’s full name:_______________________________
e-Mail: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Co-ordinator’s full telephone number: __ __ __ __ __ __ __ __ __ __ __ __ __
How many semesters have you already completed ? _______
Will the credits at I.T. Tallaght count towards your degree qualification? ______
How long (in months) have you spent in an English-speaking country? ______
OUTLINE in ca.150 words
(1) Why You Want To Study Abroad and (2) Why at I. T. Tallaght ( DUBLIN)
(1)
(2)
SPECIAL NEEDS : Please let us know if you have a physical, sensory or other disability,
which might in some way affect your studies at ITT Dublin or may require special facilities
or treatment.
YES / NO
Is your home university aware of this special need? ___________
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Include brief details of your special needs here:
WE DO NOT ACCEPT APPLICATION FORMS BY E-MAIL
Return forms BY POST ONLY to:
International Office. Attn: Tara McKiernan, ITT Dublin, Tallaght, Dublin 24. Ireland
ITT Dublin. Erasmus + Application Form 2015-2016
Closing date: 01 June 2014 for arrival in autumn 2015 or 01 November 2015 for arrival in spring 2016
Section III : Your proposed studies at I T Tallaght (Dublin).
I understand and accept the information and conditions set out on page 1 of this form.
YES
NO
Signature: _______________________________
The timetables for 2015-2016 will not be available until the first day of each semester.
Put your provisional list of modules here. Your final selection of modules must take place
after arrival at ITT Dublin.
Name of the course
Department
Year
Semester
Subject/module title
Have you studied abroad before? YES/NO. Give details: (where, when, how long)
_______________________________________________________________________
If you have an address until your arrival in Dublin that is different from your permanent
address, please write it here:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
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Date you will leave this address: __________________
WE DO NOT ACCEPT APPLICATION FORMS BY E-MAIL
Return forms BY POST ONLY to:
International Office. Attn: Tara McKiernan, ITT Dublin, Tallaght, Dublin 24. Ireland
ITT Dublin. Erasmus + Application Form 2015-2016
Closing date: 01 June 2014 for arrival in autumn 2015 or 01 November 2015 for arrival in spring 2016
Section IV : Confirmation and Declaration for 2015-2016
Academic / Administrative Confirmation
(To be completed by the academic coordinator OR international officer)
Full Name of home university:
Erasmus Code:
I.
I, (name)______________________ confirm that (student’s full name)
_________________________ is approved by me to study at ITT Dublin.
II.
This student’s current level of English is (please circle as appropriate):
A1
III.
A2
B1
B2
C1
C2
I have approved a provisional programme of study with the student.
I understand that final study choices will be made after his/her arrival.
Name & Position ________________________________________________________________
Telephone: ____________________________________________________________
email: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Date: ______________
Signature_______________________________________
University stamp / seal:
Student’s Checklist / Declaration:
(To be completed and signed by the in-coming Erasmus student)
ALL sections of this form have been completed .
YES / NO
I have used UPPERCASE / BLOCK CAPITALS where requested.
My email address is written very clearly on this form.
YES / NO
YES / NO
I am respecting the application deadline of 01/06/15 or 01/11/2015. YES / NO
This form will be posted (not emailed) by me / my coordinator. YES / NO
My final subject choices may be made after arrival in Dublin. YES / NO
I require a written letter of acceptance
YES / NO
To receive this letter of acceptance from ITT Dublin I am including with this form my own envelope
with my name and home address (without postage stamp).
Date: ___________________
WE DO NOT ACCEPT APPLICATION FORMS BY E-MAIL
Return forms BY POST ONLY to:
International Office. Attn: Tara McKiernan, ITT Dublin, Tallaght, Dublin 24. Ireland
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Student’s signature _______________________
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Student’s Name in CAPITALS: ______________________________
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