High School Programme Application

This is the full High School Programme application. Please complete all relevant sections and upload the required supporting documents. School and location preferences remain subject to eligibility, availability and school acceptance.

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Are you an agent? *

Agency name *

Student personal information

Student name *

First

Last

Programme Duration *

Term 1
Term 1+
Term 2
Term 3
Full year
Term 1 and 2
Term 2 and 3

Emergency Contact Person (Next-of-Kin)

Full name *

Mobile Phone Number *

Relationship *

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Personal information

Address Line 1 *

Address Line 2

City *

Postal Code

State / Province / Region *

Country *

Student Passport Number *

Student gender *

Student native language *

Student nationality *

Student date of birth *

Student other language *

Student Email *

Student Mobile number *

Level of English *

Elementary
Intermediate
Upper intermediate
Advanced

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Please attach 2 Passport size photos and 2 years of school reports and a copy of EHIC Card for EEA students. Non-EEA students may purchase ISI student insurance, or equivalent policy.

Passport-size photos *

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

Please upload 2 passport-size photos.

2 years of school reports *

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EHIC Card / Medical Insurance

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EEA students: please upload a copy of the EHIC Card. Non-EEA students: upload a copy of equivalent private medical insurance if already arranged. If you intend to purchase ISI student insurance, you may leave this upload blank.

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School Type Preferences

Gender

School type *

Location *

Year applying for: *

1st
2nd
3rd
4th (Transition year)
5th
6th

School preferences *

Please select up to 4 preferred schools. Preferences help us understand your interests; final placement depends on eligibility, school availability and acceptance and cannot be guaranteed.

You can choose your schools here.

€750 extra school charge applies to Cabinteely Community School for 2027/28.

€500 extra school charge applies to Rockford Manor for 2027/28.

What school are you interested in?

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Host Family Preferences

What type of room? *

Shared
Single

An additional supplement will be applied for selecting a single room.

Does applicant like pets? *

Is applicant afraid of any pets? *

What kind? *

Is applicant allergic to any animals? *

What kind? *

Does applicant have other allergies? *

What kind? *

Does applicant follow a special diet? *

What kind? *

Does applicant suffer from any physical medical condition? *

Please give specific details: *

Does applicant suffer from any mental or emotional health condition? *

Please give specific details: *

Does applicant take any medication? *

Please give specific details: *

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Parents/Legal Guardians

At least ONE name must be listed and this should be the person(s) who live(s) in the main home of the applicant.

Parent or Guardian title: *

(e.g. mother, father, stepmother etc.)

Full name *

Ocupation *

Email *

Phone *

Mobile phone *

Parent or Guardian title: *

(e.g. mother, father, stepmother etc.)

Full name *

Ocupation *

Email *

Phone

Mobile phone *

Does applicant live with both or one of the above? *

Please specify which one: *

Is anybody else Living in the Home? *

Full Name *

Age *

Gender *

Relationship to applicant *

Is anybody else Living in the Home? *

Full Name *

Age *

Gender *

Relationship to applicant *

Is anybody else Living in the Home? *

Full Name *

Age *

Gender *

Relationship to applicant *

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I hereby confirm that all of the details supplied above are accurate. I consent to having this website store my submitted information so they can respond to my inquiry.

Parent or Legal Guardian signature *

Clear Signature

Applicant signature *

Clear Signature

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Tell us more about your home and your family

What do you and your family like to do together in the evening and at weekends? (e.g. watch TV, play sports, go shopping etc.)

What are your responsibilities and chores at home (e.g. dog walking, washing dishes, tidying your room etc.)

What sports (if any) do you like to play?

What are your other hobbies or interests? (e.g. music, arts and cultural interests)

How would your friends describe your personality?

Have you ever spent time away from your family and friends? Tell us about it! How did you feel?

How do you feel about studying in Ireland, away from your friends and family?

Is there anything else, not included in this form that you would like ISI Dublin to know about you?

Tell us why you want to take part in this programme and what do you hope to achieve?

Please write a short introductory letter to your Irish host family:

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Part 4 - School Report

Please attach two recent school reports to this application. This section should be completed in English by the student's English teacher, Year Head or School Head.

How long have you known the student? *

Please state years and months.

Please give details of any learning difficulties or challenges the student has faced

How would you describe this student's personality? *

General behaviour in school / in class

Rate each item: Excellent, Good, Fair, Poor or Unknown.

Participation in class *

Personal Conduct *

Behaviour/discipline in class *

School Attendance *

Initiative in class *

Sense of responsibility *

Intellectual curiosity *

Imagination and creativity *

Communication skills *

Listening and Concentration *

How long has the student been learning English? *

English Reading *

English Writing *

English Speaking *

English Listening Comprehension *

Do you think this student would be suited to studying in Ireland? Please give reasons. *

Is there anything else the host secondary school in Ireland should know about this student?

Name of Teacher / School Head *

First

Last

School Report date *

Signature of Teacher / School Head *

Clear Signature

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Part 5 - Medical Report

This section should be completed by a family doctor via consultation with the student/parent. The doctor should have been treating the child for a period of no less than 12 months.

Height *

Weight *

How long have you been treating this student? *

How would you describe this student's overall health? *

Are there any restrictions on the student's ability to participate in physical education class and/or physical activity? *

If yes, please explain any physical activity restrictions

Has the student experienced any illness, impairment or abnormality of the listed body systems? *

Abdominal organs, bones or joints, blood or endocrine system, heart or blood vessels, brain or nervous system, genitourinary system, lungs or respiratory system, eyes, ears, skin, throat or veins.

If yes, please explain illness, impairment or abnormality

Does the student have a history or present evidence of nervous, emotional or mental conditions? *

The source form gives examples including anorexia, bulimia, self-harm, enuresis, recurrent nightmares, sleepwalking, stammering and stuttering.

If yes, please explain nervous, emotional or mental conditions

Has the student ever consulted a neurologist, psychiatrist, psychologist or other specialist in nervous, emotional or behavioural disorders? *

The source form includes panic attacks, obsessive compulsive disorder and eating disorder as examples.

If yes, please explain specialist consultations

Has the student ever been diagnosed with Autism, ADHD, Asperger's or any other similar condition? *

If yes, please explain diagnosis

Other medical, mental or emotional health conditions

Please list any other conditions you have treated this student for over the past two years and/or that you have knowledge of.

Is the student currently taking any medication (prescribed or unprescribed)? *

If yes, please supply a list of medications and instructions

Do you think this student is physically, mentally and emotionally capable of living and studying abroad for an extended period of time? *

The source form describes an extended period as 6 to 40 weeks, away from family and friends.

Please explain your answer regarding the student's capability to study abroad *

Date student was medically examined *

Doctor's Name *

First

Last

Doctor's Address *

Doctor's Telephone Number *

Doctor's Mobile Number

Doctor's Clinic / Office Stamp *

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Upload a clear image or PDF of the clinic/office stamp.

Doctor's signature *

Clear Signature

Medical Report date *

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Part 6 - Discipline & Behaviour Agreement

All students are subject to Irish law for the duration of the programme. Students are also subject to the discipline policies and rules of their Junior Programme / High School Programme / Secondary School and to the rules of their host family.

The following actions are in all circumstances prohibited:

Consuming any alcoholic beverage.
Taking any type of illegal drug or un-prescribed medicine; associating or having contact with any person involved in or associated with un-prescribed or illegal drugs. Students must inform ISI Dublin if taking prescription medication.
Smoking.
Driving a car or motorbike.
Attending an over-18s nightclub.
Staying away from the host family / residential school overnight without permission from ISI Dublin, the host family / school and parents / guardian in writing.
Being absent from school without permission.
Leaving the school premises during class or school activity without permission.
Travelling outside the residential area without permission from ISI Dublin and parents / guardian.
Borrowing money from classmates or lending money to classmates.
Inviting friends to host family / residential accommodation without prior permission from the host family and ISI Dublin.
Bullying fellow school pupils or other students on the programme.
Using mobile phones during class time.
Working. Students are not permitted to engage in paid part-time employment. Unpaid employment or work experience must be approved by ISI Dublin.
Getting a tattoo or body-piercing without permission from parents.
Cooking in the host family home without permission from the host family.
Engaging in a sexual relationship.
Any act which might cause injury to someone or damage someone's property.
Breaking curfew.
Disturbing class or behaving inappropriately or unacceptably during class.
Being absent from school without justification. The source form states that if absent for 20 days or more, the Irish Department of Education and Science will investigate and the student could be expelled from both school and the HSP programme.

Other ISI rules and guidelines:

Respect must be shown at all times to teachers, the host family, ISI Dublin staff and other students.
Students are expected to do all homework set by teachers.
Students must be home by dinner time each day, as confirmed with the host family.
Students may socialise in the LOCAL area only until 9pm Sunday-Thursday and 10pm Friday-Saturday except where special events have been organised and prior permission granted.
The host family must always be informed where the student is going, the expected return time and who will be with them.

Disciplinary Action:

Stage 1: Formal Verbal Warning (witnessed)
Stage 2: First Written Warning (signed and witnessed)
Stage 3: Final Written Warning (signed and witnessed)
Stage 4: Expulsion

In serious cases, earlier warning stages may be foregone. A student may be expelled and sent home immediately. Breaking the law in Ireland, including stealing, property damage or use of illegal drugs, may result in immediate expulsion. The source form states that there will be no refund of fees if a student is expelled from the programme.

Part 6 acknowledgement *

I have read Part 6 and agree to the Discipline & Behaviour Agreement.

Parent or Legal Guardian Name - Part 6 *

First

Last

Parent or Legal Guardian Date - Part 6 *

Parent or Legal Guardian Signature - Part 6 *

Clear Signature

Applicant Name - Part 6 *

First

Last

Applicant Date - Part 6 *

Applicant Signature - Part 6 *

Clear Signature

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Student Name - Part 7 *

Date of arrival *

Date of departure *

Part 7 - Legal Forms for Parents

This form, which covers Authorisation and Consent, GDPR and Indemnity, is to be signed by the parents or legal guardian of a student if the student is under 18 years. Until this has been signed, Study in Ireland Limited, hereinafter referred to as ISI Dublin or the school or the company, will not accept the student for a placement in any course run by it.

Authorisation and Consent of Parent(s) or Legal Guardian(s) to Study in Ireland Limited:

I / We hereby declare that I / We am / are the parent / legal guardian of the above named student and am / are entitled to full legal custody of him / her.
I / We hereby authorise ISI Dublin, its staff, servants or agents to act in loco-parentis on my / our behalf and to act as temporary guardians for my / our child for the duration of his / her stay in Ireland.
In particular I / We authorise the persons listed above to establish a place of residence for my / our child with a host family sourced and inspected by them and conforming to the Irish Department of Education and Science host family standards, or in Irish Department of Education and Science approved boarding school accommodation.
I / We understand that any damage caused to the property of the ISI Dublin host family by my / our child is our responsibility.
Where applicable, I / We further authorise one of the persons listed above to attend with my / our child the Garda National Immigration Bureau for the purposes of his / her visa application and to act on behalf of my / our child in relation to the application.
I / We hereby confirm that all questions on the programme application form have been answered correctly and honestly and that ISI Dublin has been informed of full details of any medical, mental or emotional condition and any medicines currently used.
I / We consent that ISI Dublin may pass on relevant medical information to persons that it is of vital interest to in order to keep the child safe.
I / We hereby authorise the persons listed above to administer first aid treatment for minor injuries or illnesses. In a serious injury or illness, I / We authorise them to summon professional emergency personnel to attend, transport and treat my / our child and to issue consent for x-ray, anaesthetic, blood transfusion, medication or other treatment or hospital care deemed advisable by a doctor, surgeon or other medical professional qualified to practise in Ireland. I / We understand this authority will only be used in an emergency where attempts to contact me / us have failed or are not possible in the time frame allowed.
I / We consent to the passing of relevant information to persons that it is of vital interest to in relation to child protection concerns in adherence with the Children First Act 2015.
This authorisation is effective commencing on the date of arrival in Ireland listed above and expiring at the end of the programme.
I / We agree to pay all of my / our child's expenses to ISI Dublin for the duration of the stay in Ireland and authorise ISI Dublin to act as financial sponsor for my / our child.
I / We confirm that my / our child from outside the EEA will not seek financial assistance from the Irish Government or any other Irish body and will not at any stage be a burden on the state.
I / We understand that my / our child must abide by the rules of the applicable ISI Dublin programme and that a breach may result in expulsion and return home at my / our expense.
I / We understand and agree that if enrolled on an adult programme for students aged 16+, my child may be in a class with adult students aged 18+.
I / We understand that personal data shared by us will be processed in accordance with GDPR regulations outlined below.
I / We understand that photographs and videos may be taken of my / our child during the programme and that my / our child will be given the choice to be part of them. I / We understand that these pictures may be used as part of marketing and / or social media material. This consent can be withdrawn at any time.

Neither ISI Dublin nor the persons referred to above should be construed as legal guardians of any child under 18. The use of the word guardian is solely intended to allow ISI Dublin and those persons to act in loco-parentis.

GDPR - General Data Protection Regulation for Data Processor

ISI Dublin is a Data Processor and shall process personal data only on the written instructions of the Client, who shall be the Data Controller, unless required to do so by law. Where permitted, the client will be informed of that legal requirement before processing.
ISI Dublin shall implement appropriate technical and organisational measures so that processing meets the requirements of the Regulation and protects the rights of the data subject.
ISI Dublin shall have a procedure to ensure that the client is notified prior to engagement with another supplier acting as a sub-processor of the client's personal data.
In the case of general written authorisation, ISI Dublin shall inform the client of intended additions or replacements of processors, giving the client the opportunity to object.
ISI Dublin commits to confidentiality or an appropriate obligation of confidentiality.
ISI Dublin shall take required security measures; assist the client with data-subject rights and applicable data-protection obligations; and make available information necessary to demonstrate compliance and allow for and contribute to audits, including inspections, conducted by the client or an auditor mandated by the client.

Indemnity

In consideration of Study in Ireland Ltd. agreeing to make arrangements for and authorise the staff, servants or agents of ISI Dublin, directly or through the principal, to take my / our son / daughter / ward from time to time on activities / excursions / sports and educational and cultural trips outside the premises of ISI Dublin, I / We hereby undertake to indemnify ISI Dublin, its staff, servants or agents against:

any claims, damages or costs which they or any one of them may become liable to pay in consequence of injury, damage or illness occurring during or as a result of those activities, excursions, sports and educational and cultural trips;
any claims by a third party made against them or any of them in consequence of any act or default of my / our son / daughter / ward during or as a result of those activities, excursions, sports and educational and cultural trips;
any other costs and expenses reasonably incurred by them or any of them on behalf of my / our son / daughter / ward during or as a result of those activities, excursions, sports and educational and cultural trips.

The indemnity shall not extend to claims, damages, costs or expenses to the extent that ISI Dublin and member(s) of staff are entitled to be indemnified under any policy of insurance.

It has been explained to me / us that I / We should obtain independent legal advice before signing this 3-page document titled Part 7 - Legal Forms for Parents. I / We confirm having received independent legal advice or alternatively I / We are waiving my / our right to such advice.

Part 7 acknowledgement *

I / We have read and agree to Part 7 - Legal Forms for Parents.

Parent or Legal Guardian Name - Part 7 *

First

Last

Parent or Legal Guardian Date - Part 7 *

Parent or Legal Guardian Signature - Part 7 *

Clear Signature

Witness Name *

First

Last

Witness Date *

Witness Occupation *

Witness Address *

Witness Signature *

Clear Signature

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