love learning

HOME STAY APPLICATION

Applicant’s personal details

Surname / First name
Date of birth / Occupation
Address
Telephone No / Home Work Mobile
Email address

Please complete below for each person who resides either full time or part time at your household. Do not include other overseas students residing on a temporary basis.

1 / Surname / Name
Date of birth / Occupation
Relationship to applicant above
Time spent at house / Full Time £ Weekends £ Other (specify) £
2 / Surname / Name
Date of birth / Occupation
Relationship to applicant above
Time spent at house / Full Time £ Weekends £ Other (specify) £
3 / Surname / Name
Date of birth / Occupation
Relationship to applicant above
Time spent at house / Full Time £ Weekends £ Other (specify) £
4 / Surname / Name
Date of birth / Occupation
Relationship to applicant above
Time spent at house / Full Time £ Weekends £ Other (specify) £
5 / Surname / Name
Date of birth / Occupation
Relationship to applicant above
Time spent at house / Full Time £ Weekends £ Other (specify) £
6 / Surname / Name
Date of birth / Occupation
Relationship to applicant above
Time spent at house / Full Time £ Weekends £ Other (specify) £

International Study Institute reserves the right to seek a Garda check on each household member. Has the applicant or any member of this household ever been convicted of a criminal offence? Yes £ No £

If yes, please give the details. ______

House holds that agree to collect students at the airport when required will always be given preference. We pay an allowance of Euro 45 towards your costs for this service. Are you willing to provide this service?

/ Yes £ No £

Do you allow smoking in your house?

/ Yes £ No £

Do you have a back garden?

/ Yes £ No £

Do you have pets which students may be allergic to?

/

Cat £ Dog £ Other £

Do you host students for other schools?

/

Yes £ No £

Do you have a living room where the student may mix and interact with members of the household?

/

Yes £ No £

Do you have any musical instruments which students can use?

/

Yes £ No £

Is there computer/internet access in your home which students may use?

/

Yes £ No £

Do you have house/contents insurance?

/

Yes £ No £

Bedrooms available:

Single / No / Contents: Desk £ Chair £ Wardrobe£ Bedside lamp £
Twin / No / Contents: Desk £ Chair £ Wardrobe£ Bedside lamp £
En-suite / No / Contents: Desk £ Chair £ Wardrobe£ Bedside lamp £ No Beds £

Location:

What bus route / DART / Luas would students take to get to our (off Capel Street, Dublin city centre) school from your home?
How long would this journey take approx. in morning traffic?

Secondary School Placements:

ISI Ireland also runs a High School Programme, placing international students (aged 13 – 17) into Irish secondary schools for 1 – 3 academic years. Due to the age group and the length of these programmes, households are chosen which have experience in dealing with teenagers and can provide a high level of care and attention – a home away from home. Would you be interested in hosting for this programme?

If yes, please give the names of secondary schools in your area and the bus/ DART/ Luas which the student would take to them. / 1.
2.
3.
4.
5.

Household profile:

Applicant declaration

I have read the Home Stay Guidelines and agree to abide by them. I confirm I have filled out this form accurately and truthfully. I accept that an Accommodation Officer from ISI Ireland will visit my household and assess its suitability for hosting student, prior to placing any student with me.

Signed: Date:

Please return form to:

Accommodation Officer, ISI Ireland, 4 Meetinghouse Lane, Mary’s Abbey, Dublin 7

Fax: 01-8788538 Email:

For office use only