UAS - Example Application Form
School of Mathematics, Statistics and Applied Mathematics
MA435 – Undergraduate Ambassador Module
Application Form
Please fill out this form and return it to Dr Rachel Quinlan in the School of Mathematics, Statistics and Applied Mathematics by Monday September 9 if you may be interested in taking the Undergraduate Ambassador Module (MA435) in the academic year 2013-14. You may return the form either by email to rachel.quinlan@nuigalway.ie or on paper to the Office of the School of Mathematics, Statistics and Applied Mathematics (ADB-G025 on the ground floor of Áras de Brún). By entering this application process you are not committing yourself to accepting a place on the module if one is offered. All information on this form will be handled confidentially.
SECTION 1 : Personal Details
Name : NUI Galway student number:
e-mail address : Phone number:
Programme and Year (e.g. 3rd Mathematical Studies) :
SECTION 2 : Courses taken at NUI Galway
In the tables below please list the courses that you have taken to date at NUI Galway, and the grades A,B,C or D obtained as follows : A: 85-100 B:70-84 C:55-69 D:40-54
1. 1st Year
|Subject Name (state hons or pass) |Course Code (if known) |Grade |
| | | |
| | | |
| | | |
| | | |
2. 2nd Year (list mathematical and related courses only)
|Module Name |Module Code |Grade |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
3. 3rd Year if applicable (list mathematical and related courses only)
|Module Name |Module Code |Grade |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
SECTION 3 : Information in support of your application
Please give details of any relevant experience (including any voluntary work), skills, special interests and other information that would support your application (max 200 words).
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
3 Please give clear reasons why you want to take this course and work in a school (continue on a separate sheet if necessary).
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
| |
SECTION 4 : Additional Information
Do you have any past convictions that may be relevant to this application to take a module that involves working with school children? Yes / No
Do you agree to the University seeking clearance for you to work on this module from the Garda Vetting Office? Yes / No
Signature __________________________________ Date __________________
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- completed job application form examples
- loan application form sample
- personal loan application form sample
- loan application form template
- nclex rn application form download
- new employee application form pdf
- 2019 2020 fafsa application form printable
- fafsa application form 2018 19
- fafsa application form 2019 20
- financial aid application form pdf
- financial aid application form template
- employee application form free pdf