High School 2016/2017Application Form (Nichiai)
Page | 1 Washington Lodge, Sweetbriar Park, Lower Newtown, WATERFORD X91 D935 - IRELANDInt. Tel. +353 51 877288 Fax: +353 51 854603 E mail: [email protected] Web: www.welc.ie
Version 2016
STUDENT PERSONAL DETAILS
Page 1 of 4
Please complete 4 pages and sign application form on page 4
AGENT/GROUP REFERENCE NICHIAI LTD
FIRST NAME
FAMILY NAME
HOME ADDRESS
CITY, POSTAL CODE
COUNTRY, NATIONALITY
HOME TELEPHONE & MOBILE NUMBERS (Parent/Guardian)
E-MAIL ADDRESS (Parent/Guardian)
ENGLISH LEVEL – Estimated
A1 A2 B1 B2 C1 C2
(Beginner, Elementary, Intermediate , Advanced)
DETAIL ENGLISH EXAMINATIONS TAKEN
DATE OF BIRTH
FEMALE / MALE
COURSE DETAILS
NAME OF COURSE
Full Academic Year
Term 2 & 3
Term 1 or Term 2 or Term 3
Other
School Year in Irish School
Primary: 5th or 6th class
Secondary: 1st, 2nd, 3rd, 4th/TY, 5th or 6th Year
START DATE
END DAY
High School 2016/2017Application Form (Nichiai)
Page | 2 Washington Lodge, Sweetbriar Park, Lower Newtown, WATERFORD X91 D935 - IRELANDInt. Tel. +353 51 877288 Fax: +353 51 854603 E mail: [email protected] Web: www.welc.ie
Version 2016
ACCOMODATION DETAILS
Page 2 of 4 TYPE OF ACCOMMODATION REQUIRED (HOSTFAMILY or BOARDING)
DATE ACCOMMODATION IS REQUIRED FROM
DATE ACCOMMODATION IS REQUIRED TO
ANY HEALTH PROBLEMS?
ANY ALLERGIES?
VEGETARIAN? SPECIAL DIET?
IS STUDENT ALLOWED TO SMOKE?
ISSUES WITH ANY PETS AT THE HOST FAMILY?
ARRIVAL & DEPARTURE DETAILS
ARRIVAL TRANSFER SERVICE
Travelling with group, individually or with family
AIRLINE & FLIGHT NUMBER
ARRIVAL AIRPORT: Waterford / Cork / Dublin / Shannon
DO YOU REQUIRE MEDICAL INSURANCE?
A copy must be provided to immigration for students requiring a study VISA
High School 2016/2017Application Form (Nichiai)
Page | 3 Washington Lodge, Sweetbriar Park, Lower Newtown, WATERFORD X91 D935 - IRELANDInt. Tel. +353 51 877288 Fax: +353 51 854603 E mail: [email protected] Web: www.welc.ie
Version 2016
Application Requirements
Page 3 of 4
In addition to completing this High School Junior Application Form for each student, WELC requires the following checklistof items to proceed with your application.
Application Support Documentation etc. Notes
3 Passport size photographsFull name printed on reverse or if sent by e mail full name on file attachment
School ReportLast school report with details of subjects and results, comments from teachers/tutors
English Level ReportFrom school (or English Academy) outlying level of English (oral, written & comprehension).
School reference letter This should be a more personal reference.
Parent/Guardian letterTo confirm that student can come to Ireland to do the course under guardianship of WELC.
Medical certificateFrom family doctor to say that student is fit to participate in course & detailing any allergies/conditions
Medical Card Scan of European Medical Card
Identification Scan of passport &/or National Identification CardDeposit of € 500 for state day schoolsDeposit of €1 800 - €2 800 for boarding/private schools See bank details below for bank transfer – please state student name
On receipt of the above documentation & deposit, WELC will proceed to placing student in school & host family. Once a school place is confirmed, WELC will issue invoice for fees/balance of fees due.
School places are confirmed no later than end of May for courses starting in Term 1 or for full Academic Year, in October for Term 2 and Term 2 & 3 courses and in February for Term 3 courses.
NOTE: This is subject to early receipt of applications. Early applications are advised as students are placed on waiting list on first come first serve basis. It is advised that applications for 2016/2017 academic year or terms are received in February/March for students starting course in Term 1, in September for students starting in Term 2 & January for students starting course in Term 3.
LETTERS FROM WELC CONFIRMING THE PAYMENT OF FEES, ENROLMENT DETAILS (confirmation of Irish school & host family) ARE NOT PROVIDED UNTIL COURSE FEES ARE PAID IN FULL.
BANK ACCOUNT DETAILS FOR DEPOSIT & PAYMENTS :
IBAN No: IE25BOFI 90619592783355 BIC No: BOFIIE2D
Bank Name: Bank of Ireland , Address: 60 The Quay , Waterford, Ireland
Sort Code: 90-61-95 - Account Number 92783355
Account Name: Waterford English Language Centres Ltd
High School 2016/2017Application Form (Nichiai)
Page | 4 Washington Lodge, Sweetbriar Park, Lower Newtown, WATERFORD X91 D935 - IRELANDInt. Tel. +353 51 877288 Fax: +353 51 854603 E mail: [email protected] Web: www.welc.ie
Version 2016
If you do NOT wish that your child to be included in any photographical /digital /video footage used by Waterford English Language Centres Ltd for promotion or educational purposes (e.g. website, brochures, blog, videos,).
Please tick this box
I have read and accept all the terms & conditions as stated on Waterford English Language Centres website & course description.
Signature of applicant’s Parent/Guardian.
Signature ___________________________________________________ Date ________________________
PLEASE PRINT NAME IN FULL:______________________________
ADDITIONAL STUDENT INFORMATION
Page 4 of 4
Place in family: eldest / youngest etc.
How many brothers?
How many sisters?
Height: Tall, Average, Small
Personality: Docile, Reserved ,Talkative
Maturity: Mature, Average Juvenile
Main hobbies/interests
Appetite: Poor ,Average , Good
Disco: Yes , Controlled , No
Religion: Must practice, Own Discretion, Non PractisingPocket Money: Do you wish your child’s pocket money to be administered by WELC.
If yes ,Quantity Euro (total):Payment frequency/number of payments: weekly, monthly, 1 ,2, 3 or more payments
Parents’/Guardians - Family names :
Parents’/Guardians - First names :
Parents’/Guardians - Occupations:Parents’/Guardians - contact telephone & mobile numbers
