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Family Hosting Application Form
Please answer all required questions.
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1
Which hosting period are you available for?
*
This field is required.
You can select more than one period.
Academic Year
Term 1 Sept - Dec
Term 2 Jan - May
Summer Camp - July/Aug
Mini Stays in October/ Feb/ March/ April for 5/6/7 nights
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2
In which county can you host a student?
*
This field is required.
Cavan
Dublin
Kilkenny
Sligo
Westmeath
Wicklow
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3
Mother's Name
First Name
Last Name
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4
Mother's Occupation
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5
Father's Name
First Name
Last Name
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6
Father's Occupation
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7
Do you have children living at home?
*
This field is required.
(i.e. children who will be living at home during the student's stay)
YES
NO
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8
Your Childrens Details
*
This field is required.
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9
Host Family Address
*
This field is required.
This should be your current address where student will be staying.
Street Address
Street Address Line 2
Town/City
County
Postal Code / EirCode
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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10
Phone Number
*
This field is required.
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11
E-mail
*
This field is required.
example@example.com
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12
Do you have a preference for hosting...
*
This field is required.
Male Student
Female Student
Group Leader
No preference
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13
Do you and your family have previous experience hosting a student?
*
This field is required.
YES
NO
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14
If yes, how many years?
*
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15
The family are expected to spend at least one day of the weekend with the student as a family day. Are you agreeable to this?
*
This field is required.
YES
NO
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16
If no, you can let us know the reason why this does not suit (if you wish).
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17
Are you willing to host a student with certain dietary requirements?
*
This field is required.
YES
NO
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18
Please select the dietary requirements you are comfortable accommodating.
*
This field is required.
Vegetarian
Vegan
Coeliac
Diabetic
Lactose Intolerant
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19
Does any family member smoke/vape inside?
*
This field is required.
YES
NO
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20
Do you have Wi-Fi in the house?
*
This field is required.
YES
NO
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21
If yes, are you willing to allow student access to Wi-Fi?
*
This field is required.
Yes
No
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22
Please let us know the approximate distance from your house to the school
*
This field is required.
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23
How will student get to school?
*
This field is required.
By Car
On Foot
Public Transport
Other
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24
Please let us know any information you feel is relevant to the students journey to and from school
If you have chosen 'Other' in the previous question please provide details here.
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25
Will the student have their own bedroom?
*
This field is required.
YES
NO
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26
If no, who will the student share with?
*
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27
What type of bed will the student have?
*
This field is required.
If 'Other' is selected you can give us details
Single
Double
Other
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28
Please provide details of the type of bed the student will have.
*
This field is required.
You are being asked this as you have selected 'Other' in the previous question.
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29
Is there an ensuite or shared bathroom
*
This field is required.
Ensuite
Shared Bathroom
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30
Please tick from the following list what furniture is in the student's bedroom.
*
This field is required.
Desk
Chair
Table
Study Lamp
Wardrobe
Other
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31
Please let us know what other facilities are specifically for the students use.
You have chosen 'other' in the previous question, please provide details below.
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32
Does your family have pets?
*
This field is required.
YES
NO
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33
Please describe the pets you have and whether they are kept indoors/outdoors
*
This field is required.
Please let us know any other information you might feel is relevant to the visiting student.
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34
Brief description of your interests as a family:
Please list any interests such as different sports, walking, hiking etc in which your family partakes.
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35
Further family information (if any):
Further family information which you feel might be relevant to our process of student placement
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36
I hereby declare that the information provided is correct and accurate. Any changes to the details provided will be brought to the attention of the local co-ordinator and the application amended to reflect the changes.
*
This field is required.
Please sign below, don't worry if the signature is not perfect, you will be asked to enter your name for clarity.
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37
Please type your name below
*
This field is required.
This should be the name of the person who has signed the declaration.
First Name
Last Name
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38
Date
*
This field is required.
-
Date
Day
Month
Year
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