ISI Dublin - Host Family Application Form

ABOUT YOU

Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Phone

Mobile Phone

Date of brith//

Occupation

INFORMATION ABOUT YOUR FAMILY

Any other occupants at your house?

Yes
No
Yes, sometimes

Please, could you explain to us when and why?

OCCUPANT 1 DETAILS

Occupant 1 Name

First

Last

Date of birth//

Relationship to applicant

Occupation

Time spent in home

Any other occupant?

OCCUPANT 2 DETAILS

Occupant 2 Name

First

Last

Date of birth//

Relationship to applicant

Occupation

Time spent in home

Any other occupant?

OCCUPANT 3 DETAILS

Occupant 3 Name

First

Last

Date of birth//

Relationship to applicant

Occupation

Time spent in home

Any other occupant?

OCCUPANT 4 DETAILS

Occupant 4 Name

First

Last

Relationship to applicant

Date of birth//

Occupation

Time spent in home

Any other occupant?

OCCUPANT 5 DETAILS

Occupant 5 Name

First

Last

Relationship to applicant

Date of birth//

Occupation

Time spent in home

Any other occupant?

OCCUPANT 6 DETAILS

Occupant 6 Name

First

Last

Relationship to applicant

Date of birth//

Occupation

Time spent in home

GARDA VETTING

To become a host family all applicants in the home aged 16 or above must complete Garda Vetting.

Have any occupants been convicted of a crime?

Please specifiy

STUDENTS TYPE

Please indicate the type of students you would like to host.
You can tick as many boxes as you like.

Adults

Male
Female
Mature (age 50+)
Long term (3 months+)
Short term (2 - 12 weeks)
Couples (married or unmarried)
With special diets

Teenagers aged 12+

Male
Female
Short term (1-4 weeks)
Long term (9 months Sept to June)
With special diets

Can you offer a transfer?

Do you allow smoking in the house?

FACILITIES

Do you have WIFI?

Do you have household contents insurance?

Pets in the home?

Please, specify

Dog
Cat
Other

Host for other schools?

Please check off facilities in each available bedroom:

Bedroom 1

Single
Twin
Double
Triple
Ensuite
Wardrobe
Table & chair

Do you have any other bedroom?

Bedroom 2

Single
Twin
Double
Triple
Ensuite
Wardrobe
Table & chair

Do you have any other bedroom?

Bedroom 3

Single
Twin
Double
Triple
Ensuite
Wardrobe
Table & chair

Do you have any other bedroom?

Bedroom 4

Single
Twin
Double
Triple
Ensuite
Wardrobe
Table & chair

YOUR LOCATION

Please indicate the best route to Dublin city-centre

Public transport

Which bus number?

How long to the city?

A LITTLE MORE ABOUT YOU

We send our students a short introduction describing the family or home they will stay in. Please write a short paragraph describing your family & home, your interests & hobbies, and any other information you think a new student might like to know about your home before arrival.

Profile description

We would like to send a photo of your family or home to students prior to their arrival. If you are happy to us to do do this please upload the photo below. This can be a photo of the home itself, the room or your family.

Photo to share

Click or drag files to this area to upload. You can upload up to 3 files.

Any other comments?

APPLICANT DECLARATION

I have read the ISI Home Stay Guidelines & agree to abide by them. I confirm that I have completed this form accurately & truthfully. I accept that an Accommodation Officer from ISI will visit my home and assess it's suitability for hosting a student prior to placing any student with me. I am prepared to complete Garda vetting process.

I AGREE TO ABOVE STATEMENT

Agree statement