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Www.nui.ie TWO NUI TRAVELLING STUDENTSHIPS IN THE SCIENCES ( 42,000) APPLICATION FORM 2009 Surname (as registered on university records): Forename(s) (as registered on university records): 19 Date of Birth: Gender: M F Address for Correspondence: Phone: Mobile: Email: Have you previously entered for a NUI Travelling Studentship? (tick ( ) as appropriate) NO YES If Yes , year of previous entry: Are you in receipt of funding from other source(s)? (tick ( ) as appropriate).

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