Irish-American Scholar Program – 2010-2011 Application Form

Name: ________________________________________ Telephone: ______________________

U.S. Institution: _________________________________ E-mail: ________________________

Current Address: _______________________________________________________________

                            _______________________________________________________________

Home Address:   _______________________________________________________________

                            _______________________________________________________________

Home Telephone: _______________________ Age: ______ Marital Status: ________________

Special Needs: _________________________________________________________________

Year in college: ___________ GPA at end of fall semester 2009 [must be at least 3.2]: ________

Number of academic hours completed: ___________ Major: ____________________________

I wish to study in Northern Ireland:

_____ Fall  2010       _____ Spring 2011        _____ Fall 2010 and Spring 2011

List your choice of institutions in order [1 = first choice, 2 = second choice, 3 = third choice]:

_____ Belfast Metropolitan College                  _____ Stranmillis College

_____ Queens University Belfast                      _____ University of Ulster

_____ St. Mary’s College

Applicant’s school must submit six copies of the following documents by February 1, 2010:

·  A completed nomination form

·  An official academic transcript [one original and five copies] through fall 2009

·  A 500-word essay stating the applicant’s education objectives while studying in

      Northern Ireland

·  Two letters of recommendation – one from the applicant’s academic advisor and one  

      from a faculty member or administrator at the applicant’s home institution

Submit with Monmouth College application materials to Tom Sienkewicz, Co-ordinator of Off-Campus Study, no later than January 17, 2010.