Graduate Certificate in Ethics (Health Care)
(Joint Programme: MDI/DCU)
1 Year, Part-Time
Application Form Notes: 2015-2016 Entry
Please read carefully before completing and sending the application.
1
CLOSING DATE:
 28 August 2015, however, late applications may be considered.
2
APPLICATION PROCESS:
Application Form
 A non-refundable application fee of €25 is required in order to participate on any
postgraduate course at Mater Dei Institute.
 If the application is successful a deposit to hold the place on the
course of €500 is required (Non Refundable).
 The deposit must be paid by all intending students irrespective of eligibility of grant
assistance.
 Payment by postal order or bank draft only, no cash or personal cheques accepted.
 Payment to be made to: Mater Dei Institute of Education.
Transcripts
 Only A4 sized *Certified Copies of Transcripts are accepted.
 If any award listed was in a different name from the name on this application, this
must be stated.
 If an applicant is awaiting his/her final result, a transcript of the latest results
achieved must be submitted.
 Transcripts in languages other than English must be accompanied by an English
translation, together with a copy of the original certificate indicating the award. All
translations must be done by a professional translator and certified as such.
3 ENGLISH LANGUAGE STANDARD:
 In addition to meeting particular course requirements, applicants whose first
language is not English, evidence of an acceptable TOEFL score, or equivalent
standard, is required. For details visit the DCU English Language requirements
www4.dcu.ie/registry/english.shtml
4 REFERENCES:
 References must be made available upon request.
5 COMPLETED APPLICATIONS TO:
 Admissions – GCEHC Programme
Mater Dei Institute of Education
Clonliffe Road
Dublin 3
* CERTIFIED TRUE COPIES may be obtained by bringing the original document and a photocopy to your University/College,
Garda Station (Local Police Station), Solicitor, Courthouse, or Commissioner of Oaths, and having the photocopy certified and
officially stamped as a true copy of the original. Photocopies that are not certified will not suffice. Please note that these
documents will not be returned. A `certified copy` is a photocopy of the original document certified as being a true copy by a
competent authority (that is, signed by a lawyer, Commissioner for Oaths, medical doctor, justice of the peace, university
administrator, local law enforcement officer e.g. Garda Siochana, etc.). Photocopies of `certified copies` will not be accepted.
1
For internal use only: Initials of Co-ordinator ______ Registrar: ________
Offer: 
No Offer: 
Date
ITS
ITS
ITS
Received ____________ No. ______________ Biog ___ Applic ___ Init ______ Ack ___ To Co-ord__________
From Co-ord. ________ Intv.date _______ Offer date _________ Reply date __________ Acc date __________
Graduate Certificate in Ethics
(Health Care)
Application Form: 2015-2016 Entry
It is important to read the notes (previous page) before completing and submitting the application
Ethics
(Part-time)
Mode of study:
One year, part-time only
Customary Name: ______________________________________________________________________
Surname
First Name
(to be used on all official college records including award parchments)
Second Name
Name as on
birth certificate:
______________________________________________________________________
(if different from above) Surname
First Name
Second Name
Title:
Ms
Mrs
Miss
Sr
Dr
Mr
Rev
Address:
Home Telephone No:
Mobile Telephone No:
Work Telephone No:
Email Address:
Date of Birth (DD, MM, YYYY):
/
/
Nationality:
Country of Birth:
Passport Number (not required if nationality is Irish):
MDI Student Number (if applicable):
How did you hear about this programme?
Native Language:
Br
2
Academic Qualifications (See Academic transcripts in Notes):
Primary Degree
or
Equivalent
Qualification
National
Framework of
Qualifications
Level (if known)
ECTS
Credits
of the
Award
Name and
address of
Institution
Subject
s
taken
Year
started
Year
graduated
Award
Classification
Professional Qualifications:
Please indicate the reasons why you wish to apply for this programme
You may use an additional sheet to elaborate further:
Please indicate any relevant experience in support of your application (involvement in organisations,
responsibilities, dates, etc.). You may use an additional sheet to elaborate further:
Declaration
I declare that the information given by me in this application is true and accurate and that if I am admitted as a student I
will abide by the regulations of Mater Dei Institute and DCU. The Institutions reserve the right not to consider applications,
and to cancel any offers of places where information requested has not been supplied, or where false or misleading
information has been given.
Signature of applicant
Date