High School Programme Application form - High School in Ireland

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Are you an agent? *

Agency name *

Student personal information

Student name *

First

Last

Programme Duration *

Full year
Term 1
Term 2
Term 3

Emergency Contact Person (Next-of-Kin)

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Full name *

Mobile Phone Number *

Relationship *

Personal information

Address Line 1 *

Address Line 2

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City *

Postal Code

State / Province / Region *

Country *

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Student Passport Number *

Student gender *

Student native language *

Student nationality *

Student date of birth *

Student other language *

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Student Email *

Student Mobile number *

Level of English *

Elementary
Intermediate
Upper intermediate
Advanced

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 photo *

Click or drag a file to this area to upload.

2 years of school reports *

Click or drag a file to this area to upload.

EHIC Card for EEA students *

Click or drag a file to this area to upload.

School Type Preferences

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Gender

School type *

Location *

Year applying for: *

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

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School preferences *

Please select at least 4 schools.

You can choose your schools here.

What school are you interested in?

Host Family Preferences

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Family type *

With Children
Without Children

Does applicant like pets? *

What kind? *

Does applicant have pets at home? *

What kind? *

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Is applicant afraid of any pets? *

What kind? *

Is applicant allergic to any animals? *

What kind? *

Does applicant have other allergies? *

What kind? *

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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: *

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Does applicant take any medication? *

Please give specific details: *

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.

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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 *

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

Please specify which one: *

Is anybody else Living in the Home? *

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Full Name *

Age *

Gender *

Relationship to applicant *

Is anybody else Living in the Home? *

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Full Name *

Age *

Gender *

Relationship to applicant *

Is anybody else Living in the Home? *

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Full Name *

Age *

Gender *

Relationship to applicant *

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 *

Applicant signature *

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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