UNIVERSITY COLLEGE DUBLIN
AN COLAISTE OLLSCOILE, BAILE ATHA CLIATH
THE LORD EDWARD FITZGERALD MEMORIAL FUND 2010/11
APPLICATION FORM
(Please type or use block letters throughout)
* Every candidate must have been born in Ireland or be of a parent who was born in Ireland or
have been ordinarily resident in Ireland for at least ten years. (Preference to natives or
residents of the County of Dun Laoghaire Rathdown)
* Any candidate who ceases to be a member of the University or fails to comply with
any conditions of his/her grant/bursary shall vacate or surrender the grant/bursary
and shall not be entitled to any instalment of his/her grant or bursary falling due after
his/her ceasing to attend or comply with any such conditions.
1. Name In Full ____________________________________________________________
2. Student Number_________________________________________________________
3. Current address__________________________________________________________
__________________________________________________________
__________________________________________________________
3. Mobile Telephone Number__________________________________________________
4. Date Of Birth (please enclose copy of birth certificate)_____________________________
5. Place Of Birth____________________________________________________________
(Please tick as appropriate)
County Of Dun Laoghaire Rathdown Native
Resident
6.
How long have you resided In the County of Dun Laoghaire Rathdown ______________
UNIVERSITY CAREER
1. Degree and year registered for 2010/11_______________________________________
2. Primary Degree, and University:_____________________________________________
3. Year in which Primary Degree awarded_______________________________________
4. Grades awarded in Degree, and where appropriate, subject(s)
_______________________________________________________________________
_______________________________________________________________________
5. Other Degree(s) or qualification(s). Please give details and year of
award__________________________________________________________________
_______________________________________________________________________
EMPLOYMENT
1. Present employment, if any _________________________________________________
2. Positions held in the recent past _____________________________________________
_______________________________________________________________________
3. Are you employed as a tutor or demonstrator in UCD in the current academic
session?________________________________________________________________
FINANCIAL DETAILS
4. Are you currently or have you ever been in receipt of any other award? If so please give
details:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
5. Do you intend to apply for a local authority or other grant (eg. Government of Ireland) for
Session 2010/2011? If so, please specify the funding source:
_______________________________________________________________________
REFERENCES
Please name two people (at least one under whom you have studied) with email addresses.
Candidates should ask these two referees to send their confidential references direct to the
Chairman, The Lord Edward Fitzgerald Memorial Fund, College Office, College of
Engineering, Mathematical and Physical Sciences, UCD Engineering and Materials Science
Centre, University College Dublin, Belfield, Dublin 4 by the closing date of Friday 15 October
2010. These references SHOULD NOT accompany the candidate’s application for the
bursary.
1. _______________________________________________________________________
_______________________________________________________________________
2. _______________________________________________________________________
_______________________________________________________________________
Signature ______________________________ Date __________________________
Short statement (Preferably typed), maximum length 300 words, outlining your reasons for
undertaking research overseas and the benefits you expect to gain from the experience. If
relevant, please supply the name of the academic and University who will be hosting you.
Thesis Title:
__________________________________________________________________________
UCD School in which you are registered for postgraduate studies:
__________________________________________________________________________
Name of Supervisor:
___________________________________________________________________________