St. Leo's College Application Form for Admission to Special Class 2026-2027

Parent/Guardian Email Address

example@example.com

Student Name:*

First NameLast Name

Student Date of Birth:*

Date

Student PPSN:*

Student Nationality:*

Mother's Maiden Name:*

Required by Department of Education for registration.

Address:*

Address Line 1

Address Line 2

TownCounty

Eircode

Parent / Guardian 1 - relationship to student:*

MotherFatherGuardian

Parent / Guardian 1 Full Name:*

First NameLast Name

E-mail for Correspondence:*

example@example.com

Mobile Number for SMS Messages:*

Format: (000) 000-0000.

Parent / Guardian 2 - relationship to student:*

MotherFatherGuardian

Parent / Guardian 2 Full Name:

First NameLast Name

Parent / Guardian 2 Email:

example@example.com

Parent / Guardian 2 Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Primary School Attended:*

Please enter the name and address of the Primary School if not included in drop down list above:

Does the pupil have any sisters who currently attend or who have completed their Education in St. Leo's College :*

YesNo

Name of Sister(s) - Current Student(s)

First NameLast Name

Name of Sister(s) - Current Student(s)

First NameLast Name

Name of Sister(s) - Former Student(s)

First NameLast Name

Name of Sister(s) - Former Student(s)

First NameLast Name

Please confirm if this pupil’s mother is a former student of St. Leo’s College*

YesNo

In order for a student to be enrolled in the Special Class, the student must have a primary diagnosis of Autism/Autistic Spectrum Disorder. The following evidence is required in support of an application:

Professional report(s) outlining:

- Diagnosis of Special Educational Needs (e.g. Autism: DSM IV/V or ICD 10/11)

AND

- A demonstration of the understanding of complexity of the child’s overall level of need/s evidenced in the professional reports

AND

- Given the severity or complexity of the child’s support needs, a clear professional recommendation as to what educational placement type would be most appropriate to best meet the child’s needs, along with the rationale for same

AND

- A letter from the NCSE confirming that the child is known to them and that the child has the required diagnosis and recommendation for a special class for autism.

NB: This letter must be for the 26/27 academic year. Please send a copy of the NCSE letter and relevant documentation to enrolments@stleoscarlow.ie or the school office before the closing date for applications.

Signature