High School Programme Application form - High School in Ireland

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Are you an agent? *

Agency name *

Student personal information

Student name *

Nome

Cognome

Programme Duration *

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

Paese *

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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 *

Fai clic o trascina il file su quest'area per caricarlo.

2 years of school reports *

Fai clic o trascina il file su quest'area per caricarlo.

EHIC Card for EEA students *

Fai clic o trascina il file su quest'area per caricarlo.

School Type Preferences

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Gender

School type *

Ubicazione *

Year applying for: *

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

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School preferences *

Please select 10 schools. We will place you in one of these schools.

You can choose your schools here.

€500 extra fee.

What school are you interested in?

Host Family Preferences

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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? *

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Is applicant allergic to any animals? *

What kind? *

Does applicant have other allergies? *

What kind? *

Does applicant follow a special diet? *

What kind? *

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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: *

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 *

Pulisci la firma

Applicant signature *

Pulisci la firma

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:

Aggiornamento dell'anteprima...

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