Overseas Final Course Acceptance form.

Irish Students Studying Overseas
Final Course Acceptance Form (FCA)
Instructions
You are required to complete the final course acceptance form for SUSI to be aware which approved College and
Course you have selected to continue your education. Make sure that all parts 1-4 of this form are completed and
signed .
Part 1 – Applicant’s Personal Details
Name:
_ SUSI Application Number:
Home Address:
PPS No: _ _ _ _ _ _ _
Date of Birth: ___ / ___ / ______
Part 2a–Institution and Course Details
Name and address of Institution:
______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Title of Approved Course:
Course Code (where applicable)
Level of course: (please tick the relevant relevant)
Undergraduate: Level 6 ⃝ Level 7 ⃝ Level 8 ⃝
Postgraduate: Higher Diploma (HDip) ⃝ Postgraduate Diploma ⃝ Masters Degree ⃝ Doctorate (PhD) ⃝
Course duration in years:
1 ⃝ 2 ⃝ 3 ⃝ 4 ⃝ If more than 4 years please write the number of years here:
Course Year in 2014/15:
1⃝2⃝3⃝4⃝
Is this year a repeat year? Yes ⃝ No ⃝
Is this course full-time? Yes ⃝ No ⃝
Part 2b Course details (to be completed by college/institution official on registration if the college/
institution is outside of the Republic of Ireland)
I certify that the above educational institution (please tick as applicable):

Provides higher education and training

Is situated in a Member State of the EU

Is maintained or assisted by recurrent
grants from public/government funds

This student has accepted a place in this
college/institution for the 2014/15
academic year

he details as completed in Part 2a
above are correct and accurate to the
best of my knowledge

The course leads to a recognised higher
education and training award in line
with the laws of the Member State.
I certify that:
I undertake to confirm registration of this student on this course and to verify to the grant awarding
authority at agreed intervals that he/she is continuing to attend the course.
Signature:
Name block Capitals:_
Contact Number:
Date:
/
Contact email address:
/
Official stamp of College/Institution/University
Part 3 – Details of other financial assistance including BTEA and VTOS (to be completed by the applicant)
Have you applied for or will you be getting a Back to Education Allowance (BTEA) or a Vocational Training
Opportunities Scheme (VTOS) payment for the 2014/15 academic year? Yes ⃝ No ⃝
Have you applied for or will you be getting any other student financial assistance from Ireland or abroad
for the 2014/15 academic year? Yes ⃝ No ⃝
If yes, please submit documentary evidence of all awards/funds from the awarding/funding body or
Department and the full amount, including fees that you will get in 2014/15.
Part 4– Declaration and Signature (to be completed by the applicant)
If I am awarded any funding from SUSI for the 2014/2015 academic year, I will accept the offer subject to
the conditions of the Student Grants Scheme 2014.
I confirm I will not be in receipt of:
a) any grant from an awarding authority
b) any other award payable from public funds as listed in Part 2 Article 14 of the Student Grant
Scheme 2014 c)the equivalent of (a) or (b) from another EU Member State, a contracting
state to the EEA Agreement or the Swiss Confederation
d) a Back to Education Allowance payment or a payment under the Vocational Training Opportunities
Scheme (VTOS).
e) I realise that in the event of my accepting another Scholarship, Grant or Bursary I undertake to
repay to SUSI any payments made to me in respect of this grant. I undertake to repay any portion of
the grant that may be subsequently withdrawn pursuant to the relevant clauses within the Student
Grants Scheme 2014.
I undertake to notify SUSI immediately of any change in my course, college or institution, duration or
attendance pattern, social welfare entitlement or other sources of student financial assistance.
I will also notify SUSI if I defer attendance on this course, or if having commenced the course, I cease to
continue to attend.
Name:
SUSI Application Number:
Signature of Applicant:
Date:
/
/
This form should be completed after you have made your final acceptance of a place on an approved
fulltime course and have applied for a student grant for 2014/15. The completed form should then be
returned to:
Student Universal Support Ireland
P.O. Box 869,
Togher,
Cork

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