Todo Libro

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||STUDENTS EXCHANGE 2012-2013 |
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Application Form

Attach passport-sized photograph here

To be completed by the student.

Name____________________________________________ Date of Birth: _____/______/__ ___
Address _________________________________________
_________________________________________ Phone No ___________________E-mail address __________________ ______________________ Mobile No. ___________________


B. FAMILY
Brothers (names & ages) ____________________________________________
Sisters (names &ages ) _____________________________________________
Parents’ Occupations: Father: _____________________ Mother: ____________________
Any Pets:______________________________________________


C. DOMESTIC ARRANGEMENTS

Would you be willing to share a room in the host family’s house? Yes ( No (




Will your Irish exchange partner have a separateroom in your house? Yes ( No (









D. HEALTH: Please attach any medical details or provide all relevant information which the host family should be aware of in relation to thefollowing:
1. Recent illnesses: _____________________________________________________
______________________________________________________________________2. Disabilities (including mobility requirements): _____________________________
______________________________________________________________________
3. Current...