Application Form - Bahrain - Institute of Leadership
Application Form - Bahrain - Institute of Leadership
Application Form - Bahrain - Institute of Leadership
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Royal College <strong>of</strong> Surgeons in Ireland<br />
Academic Programme <strong>Application</strong> <strong>Form</strong><br />
BAHRAIN<br />
***Completing Your <strong>Application</strong> <strong>Form</strong>***<br />
Please complete in BLOCK CAPITAL LETTERS using a BLACK pen.<br />
Complete all sections, adding extra labelled sheets if necessary.<br />
Attach 1 x photo here<br />
PERSONAL DETAILS:<br />
Title (Mr/Dr/Ms/etc.) :<br />
Family Name (Surname):<br />
First Name:<br />
Date <strong>of</strong> Birth:<br />
(Required for Higher Education Authority - Ireland)<br />
Previous RCSI Student No. (if applicable) :<br />
Address for ALL Correspondence<br />
Address<br />
Tel:<br />
Mobile:<br />
Email:<br />
Nationality:<br />
For <strong>of</strong>fice use only<br />
Program: Ack: Com:<br />
OS: OL: ACC:<br />
QUE:<br />
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SOURCE OF FUNDING: (Please Tick)<br />
Self<br />
Employer:<br />
Other Funding (please state):<br />
PROGRAMME YOU WISH TO UNDERTAKE (please ensure you tick clearly):<br />
MSc/Post Graduate Programmes:<br />
MSc/Postgrad Dip. in Healthcare Management<br />
MSc/Postgrad Dip. in Quality & Safety in Healthcare Management<br />
Diploma in <strong>Leadership</strong> & Organisational Development<br />
WHERE DID YOU HEAR ABOUT OUR PROGRAMMES (Please Tick)<br />
Website:<br />
Employer:<br />
Exhibition:<br />
Current/past student:<br />
Newspaper/Magazine (specify):<br />
Other (specify):<br />
EMPLOYMENT HISTORY:<br />
The following section must be completed - do not substitute with a CV<br />
Employer Name & Address (present first) :<br />
Job Title:<br />
From<br />
Dates:<br />
To<br />
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HIGHER EDUCATION and/or PROFESSIONAL QUALIFICATIONS (in date order, most recent first)<br />
University<br />
Completed Qualification Subject<br />
Language <strong>of</strong><br />
instruction<br />
Result<br />
GPA*<br />
ENGLISH LANGUAGE QUALIFICATIONS: (only for applications to RCSI-<strong>Bahrain</strong> & RCSI-Dubai )<br />
IELTS:<br />
Listening: Reading: Writing:<br />
Speaking:<br />
TOEFL:<br />
Overall<br />
Band:<br />
Total Score:<br />
Test if Written English/Essay Score:<br />
OTHER COURSES & EXPERIENCE: (relevant to your application)<br />
Date <strong>of</strong> Course Title <strong>of</strong> Course Qualification (including grade)<br />
PLEASE NOTE: All information is kept confidential and used only for the purpose for which it was collected. Only<br />
completed application forms will be reviewed. CVs may be attached as additional information but not as a substitute<br />
for the application form.<br />
CHECKLIST FOR YOUR APPLICATION:<br />
1.Completed <strong>Application</strong> <strong>Form</strong> (additional information & CV may also be attached)<br />
2. Official Degree/Pr<strong>of</strong>essional Qualification Transcripts (original or notarised copy)<br />
3. Passport-size Photo (attached to page 1)<br />
4. English Certificate <strong>of</strong> Competency (where English is not your first language)<br />
* GPA Grade Point Average (Check with university where you completed your degree for this calculation)<br />
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APPLICATION SUBMISSION DETAILS:<br />
Please note, you may be additionally requested to submit references<br />
<strong>Institute</strong> <strong>of</strong> <strong>Leadership</strong> & Healthcare Management,<br />
Royal College <strong>of</strong> Surgeons in Ireland - <strong>Bahrain</strong>,<br />
PO Box 15503,<br />
Busaiteen,<br />
KINGDOM OF BAHRAIN<br />
Tel:<br />
Fax:<br />
Website:<br />
+ 973 17 351 450 Ext 2490<br />
+ 973 17 583 600<br />
www.rcsileadership.org<br />
Please read the following before signing your <strong>Application</strong> <strong>Form</strong>:<br />
I certify that the information on this application form is complete and accurate.<br />
Signature:<br />
Date:<br />
Please tick this box if you DO NOT wish to receive marketing information from the RCSI<br />
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