1
Apply by Friday, 10th July 2020 at 5pm
GMIT awards up to twelve financial scholarships to the value of €5,000 each to support students entering GMIT who are from socio-economically or other disadvantaged backgrounds, or those who have faced difficult personal circumstances. This financial scholarship is provided in increments over the duration of the programme of study.
In addition, scholarship applicants may be eligible for a reduced points offer of up to 50 CAO points, subject to availability.
Note: Applicants must have taken the Leaving Certificate exams within the last two years.
A candidate must satisfy the following conditions: 1. Be an EU citizen.2. Have taken the Leaving Certificate exams within the last two years.3. Be a current applicant for a GMIT programme through the CAO and satisfy the general
and specific criteria for entry.4. Have family income under the current threshold for the third-level maintenance grant
scheme.5. Be supported by an academic reference from his/her school.
Criteria for Selection
• Completed application form.• Compliance with conditions specified at 1, 2, 3, 4 and 5 above.• Leaving Certificate points within 50 points of the first-round cut-off points for the
chosen programme.• Academic reference.• Interest, knowledge and commitment to the chosen programme.• Socio-economic factors considered:
- geographical relocation to attend GMIT- lone parent family- exceptional circumstances- social welfare/low income- applicant is the first member in family to attend third level education
Nominated candidates may be short-listed. Those short-listed will be interviewed in August (following Leaving Certificate results and CAO first round offers).
ACCESS SCHOLARSHIP FORM
2
PERSONAL INFORMATION
CAO Application Number
Country of Birth: Are you an Irish Citizen: Yes No
If you ticked no, please explain:
EDUCATIONAL INFORMATION
Second Level Attendance Dates Attended
School(s) Attended From: To:
Please give your name as it appears on your CAO Form
Full Name: First Name Surname
Correspondence Address:
Home Address:
Eircode: Eircode:
Insert your contact mobile number below: Insert below the contact number of a parent/guardian:
Email Address: Date of Birth:
What gender do you identify as? (tick one) Nationality/Citizenship Status:
Male Female Other
3
Second Level Examinations
Junior Certificate Year: (date dd/mm/year)
Leaving Certificate Year: (date dd/mm/year)
Subject Level Grade Subject Level Grade
4
List the GMIT courses you applied for - in the same order of preference as your CAO Form
CAO Course Code GMIT Programme Title
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
PERSONAL STATEMENT
In this section, we want to learn more about you.
In the Personal Statement, describe (using a maximum of 200 words) why you wish to pursue a third level programme of study, and the challenges or difficulties you experience in relation to your personal life (this will assist in the assessment of your application).
Describe: - How these challenges or difficulties have affected your preparation for the Leaving
Certificate- How these challenges or difficulties might impact your transition to third level education- How you think these challenges or difficulties could be made easier with the right
supports in place
5
Please type here:
Note: If you are handwriting your personal statement, you can insert additional pages in your hard copy.
Interests and Hobbies Please give a brief description of interests and hobbies that you enjoy in your spare time
What do you enjoy?
6
FAMILY AND INCOME DETAILS (to be completed by Parent(s) or Guardian)
Household Income for 2019
In this section, we will ask you questions on Family Income and Family Size (dependents)
In order to fully assess your scholarship application, you must provide proof of household income
relating to 2019.
All relevant proof of income documents must be submitted together with the application form as
the form cannot be assessed without these and will be returned to the applicant.
• SUSI Assessed Reckonable Income 2019, OR
• If on Social Welfare – A statement from the Social Welfare Office stating the total
amount received in 2019 (Back to Education, Job Seekers Allowance,
Carers/Disability Allowance, Lone Parents Allowance, FIS, Farm Assist, Rent
Allowance, Child Maintenance, Fuel Allowance etc.)
- These documents can be accessed by making a request on
www.welfare.ie.
- You will be required to quote your PPS number.
• If Employed – A P21 (End of Year Statement) for 2019
- This document is available on www.revenue.ie.
• Income from employment (including benefit-in-kind and directorships)
• Rental and other income from land and property
• Income from pensions
• Income from savings, deposit accounts and investments
• Lump sum payments from retirement and redundancy
• Income from the disposal of assets or rights
• Gifts and inheritances (you must fill out gifts/inheritance table)
• Income from other sources not mentioned above
• If Self Employed/Farmer – A Notice of Assessment for 2019
- This document is available on www.revenue.ie.
7
Documents needed from Parent(s)/ Guardian (to be attached with this form)
1. If employed in 2019, please upload a P21 (End of Year Statement) for that period(this form can be accessed from Revenue)
2. If on Social Welfare, upload statement from Social Welfare Office stating totalamount received in 2019
3. If Self Employed/Farmer in 2019 - please upload:o Your Revenue Calculation Statemento Breakdown of your Profit & Loss Account
Please list the occupation(s) of Parent(s)/Guardian
Father Mother Guardian
Occupation
Family and Dependents
Name Date of Birth
(dd/mm/year)
Relationship to
Applicant
Is this person currently living in the family home?
Highest level of education achieved to date*
Current/most recent occupation or current place of study
Yes No
First Name
Surname
First Name
8
Surname
First Name
Surname
First Name
Surname
First Name
Surname
First Name
Surname
*Level of education i.e. Primary education, Group/Inter/Junior Certificate, Leaving Certificate, PLC,Adult Education, Certificate, Diploma, Degree, Master’s Degree, etc.
PLACE OF RESIDENCE (Please tick the appropriate box)
Home Owner Private rented accommodation
Local Authority tenant purchase Local Authority rented flat
Scheme Local Authority rented flat Other non-permanent accommodation (please provide details)
9
Applicant Family Status (Please tick the appropriate box)
Married Single
Co-habiting Separated
Widowed Divorced
Unaccompanied adult Unaccompanied Minor
Other: (please specify)
Medical Card (Please tick the appropriate box) Yes No
Do you have a full Medical Card?
Please enter your Medical Card number here.
Do you have a GP Only Medical Card?
DECLARATION (must be signed by both applicant & his/her parent/guardian)
I declare that all the information provided is true, complete and accurate and refers to me, the applicant. I declare that assistance from other sources has not been received for the stated purpose/service which is the subject of this application.
I agree that all funding received will be used for the purpose intended.
I agree
Other
If you ticked ‘Other’ – please explain:
10
Signature of Applicant (type signature) Signature of Parent/Guardian (type signature)
Date: (dd/mm/year) Date: (dd/mm/year)
REMINDER - you must submit to GMIT by the closing date of July 10th 2020, at 5pm.
• This completed form
• Including all relevant Financial Documentations
• The Referee Report
You can print out the Referee Report form (last two pages here) or ask your school to download it from the GMIT Website. Please remember to attach all additional documents if emailing ATS directly ([email protected]).
11
Referee Report (To be completed by the School Principal/Guidance Counsellor or Year Head.)
The completed form should be returned by 15th June 2020 to:
POST TO:
Attract, Transition, Succeed (ATS) Office,
Student Services - GMIT
Dublin Road
Galway
Email: [email protected]
Name of Applicant: School Attended:
LEAVING CERTIFICATE SUBJECTS - 2020
Subject Level of Exam (H/O))
12
School Performance of Student (to be completed by the School Principal/Guidance Counsellor or Year Head)
Rating Description Indicators of Performance Very Good
Above Average
Average Below Average
Poor
Motivation
Determination
Record of Attendance
Literacy Level
Numeracy Level
Adaptability/ Resilience
Coping Abilities
13
Additional Comments
1. What supports do you think the applicant would require in order to ensure success incollege?
2. Is there any other information that would support the student’s application?
Signed: Position held:
Contact Number: Date:
Thank you for completing this report
Important
Remember! Email or Post
1.Competed Form 2.Referee Report 3.All the necessary FinancialDocuments
Email: [email protected] Post: Attract, Transition, Succeed (ATS) Office Student Services – GMIT Galway Campus Dublin Road Galway
14