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IONTRÁIL / ENROLMENT

Bliain Iontrála / Enrolment Year:

Cur tic leis an mbliainghrúpa ar a bhfuil an dalta ag déanamh iarratais / Please tick the Year Group the student is applying to enter:

SONRAÍ DALTA IONCHASACH / PROSPECTIVE STUDENT DETAILS

Céad Ainm: / First Name:

Dara hAinm: / Middle Name:

Sloinne:/ Surname:

Dáta Breithe /DOB :

Gnéas / Gender:

UPSP: / PPSN:

Seoladh an Dalta:/ Student Address:

Town:

County:

Éirchód: / Eircode:

SONRAÍ TUISMITHEORA/CAOMHNÓRA / DETAILS OF PARENT/GUARDIAN

CéadAinm: / First Name: (Tuismitheoir 1)

Sloinne: / Surname:

Ainm roimh Phósadh / Maiden Name:

Seoladh: / Address:

Éirchód: / Eircode:

Uimh. Gutháin / Telephone No.:

Seoladh Ríomhphoist: / Email address::

Gaol leis an Dalta: / Relationship to Student:

CéadAinm: / First Name (Tuismitheoir 2):

Sloinne: / Surname:

Seoladh: / Address:

Éirchód: / Eircode:

Uimh. Gutháin / Telephone no.:

Seoladh Ríomhphoist: / Email address::

Gaol leis an Dalta: / Relationship to Student:

Eolais Breise / Additional Information:

Bunscoil a d'fhreastail on dalta uirthi / Details of Primary school attended:

Ainm na scoile:/ School name:

Seoladh na scoile:/ School address:

Leigheas / Medical Information

Ainm Doctitúra / Family Doctor:

Uimhir Fóin / Phone Number:

Cárta Leighis / Medical Card:

An bhfuil aon ailléirgí ag do mhac/iníon? / Does you son/daughter have any allergies?:

An bhfuil aon fadhbanna leighis ag do mhac/iníon / Does your son/daughter have any medical issue (conditions)?:

Stair Oideachais / Educational History

An bhfuil do mhac/iníon ag fail aon cúnamh breise ar scoil? Is your son/daughter receiving any additional learning support?:

CÓD IOMPAIR NA nDALTA

Deimhnigh, mar thuismitheoir/caomhnóir, go nglacann tú le Cód Iompair na nDaltaí agus go ndéanfaidh tú gach iarracht réasúnta lena chinntiú go gcloífidh an dalta leis an gcód má éiríonn leis/léi áit a fháil sa scoil. Tabhair ar aird gur féidir an Cód Iompair a fháil ar www.colaistenacoiribe.ie nó ó oifig na scoile.

Please confirm that the Student Code of Behaviour is acceptable to you as a parent/guardian and that you shall make all reasonable efforts to ensure compliance of same by the student if s/he secures a place in the school. Please note that the Code of Behaviour can be found at www.colaistenacoiribe.ie or from the school office.

Deimhnímse, mar thuismitheoir/caomhnóir an dalta, go nglacaim le Cód Iompair na nDaltaí agus go ndéanfaidh mé gach iarracht réasúnta lena chinntiú go gcloífidh an dalta leis an gcód má éiríonn leis/léi áit a fháil sa scoil

I confirm that the Code of Behaviour for the school is acceptable to me as the student’s parent/guardian and I shall make all reasonable efforts to ensure compliance by the student if s/he secures a place in the school.

CRITÉIR ROGHNÚCHÁIN D'IARRATAS SA CHÁS GO BHFUIL RÓ-IARRATAS I gCEIST / SELECTION CRITERIA FOR ADMISSION IN THE EVENT OF OVERSUBSCRIPTION

Cuideoidh an fhaisnéis seo lena chinntiú cé acu an sásaíonn an dalta riachtanais iontrála de réir ord tosaíochta mar atá leagtha amach san alt mar atá infheidhme i gCuid B de Pholasaí Iontrála Coláiste na Coiribe nó mura sásaíonn.

This information will assist in determining whether the student meets the admission requirements in accordance with the order of priority as set out in the applicable section of Part B of the Admission Policy for Coláiste na Coiribe

SIBLINI SA SCOIL FAOI LÁTHAIR / BROTHERS OF SISTERS IN SCHOOL AT PRESENT

Má tá siblíní leis an dalta sa scoil faoi láthair, tabhair a n-ainmneacha agus an bhliain ina bhfuil siad faoi láthair.

If the student currently has any siblings in this school, please indicate their names and current year of study:

SIBLINI SA SCOIL ROIME SEO / SIBLINGS PREVIOUSLY IN THE SCHOOL

Má bhí siblíní leis an dalta sa scoil roimhe seo, tabhair a n-ainmneacha agus na blianta a d'fhreastail siad ar an scoil.

If the student has previously had any siblings in this school, please indicate their names and years of attendance:

GAEILGE

Sa chás go bhfuil daltaí ag lorg áit i gColáiste na Coiribe, tabhair eolas thíos le do thoil a thabharfaidh leibhéal líofachta an dalta mar ghnáthmhodh cumarsáide le fios. (níl an t-eolas seo páirteach sa chritéir roghnúcháin) /

Where the student is seeking a place in Coláiste na Coiribe, please provide information below as an indication of the student’s level of fluency as a normal means of communication. Please indicate all that apply: (Not part of selection criteria)

An labhraítear Gaeilge sa bhaile go rialta: / Is Irish regularly spoken at home:

An bhfuil cónaí air/uirthi i gceantar Gaeltachta: / Is s/he resident in a Gaeltacht area:

Fachtóir ar bith eile a mheasann tú a bheadh ábhartha chun líofacht a léiriú mar aon leis an gcaoi a rachadh an líofacht sin in olcas mura ligfí an dalta isteach sa scoil: /

Any other factor that you feel may be relevant to demonstrate fluency and how same would regress if the student were not admitted to the school:

Additional Information

An imríonn sé/sí spórt – Cén sport? / Does her/she play sport - What sports?:

Ábhair Spéise Eile / Other interests and achievements:

Aon rud eile suimiúil mar eolas ? / Anything else which would be of interest?:

EOLAS TÁBHACHTACH / IMPORTANT INFORMATION

Glactar leis an bhfaisnéis ar fad a chur tú ar fáil sa bhfoirm iarratais seo de mheon macánta. Má fhaightear amach go bhfuil aon chuid den fhaisnéis míchruinn, míthreorach nó neamhiomlán, d'fhéadfadh an t-iarratas a bheith neamhbhailí mar thoradh air sin.
Tuig le do thoil gur ortsa atá an fhreagracht an scoil a chur ar an eolas maidir le haon athrú a thagann ar fhaisnéis teagmhála nó maidir le haon athrú ar chúinsí a bhainfeadh leis an iarratas seo.
Chun eolas a fháil maidir le mar a dhéanann an scoil agus GRETB do chuid sonraí a phróiseáil, féach an chéad leathanach eile.
Sínigh thíos chun a léiriú go bhfuil an t-eolas seo léite agat agus go dtuigeann tú é.

Nóta: Sa chás go n-éiríonn leis an dalta áit a fháil i gColáiste na Coiribe, níl aon ghealltanas ann go sannfar rogha ábhar roghnaithe an dalta air/uirthi de bharr saincheisteanna acmhainne agus/nó srianta maidir le líon na ndaltaí in aghaidh an ranga

All of the information that you provide in this application form is taken in good faith. If it is found that any of the information is incorrect, misleading or incomplete, the application may be rendered invalid.
Please understand that it your responsibility to inform the school of any change in contact information or circumstances relating to this application.

Deimhnimse, mar thuismitheoir / coomhnóir go nglacaim leis na coinníollacha luáte thuas / I confirm that the above conditions are acceptable:

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