Marian College Induction form 2nd-6th Year Application Step 1 of 3 33% Please state the year of entry Parents/Guardians must complete this form as fully as possible. All the information on this form will be confidential to the Pastoral Care team at the College.SECTION A – HOME DETAILSStudent’s first name & surname(Required) First Last Date of birth(Required) DD slash MM slash YYYY Student’s PPSN number(Required) (THIS IS ESSENTIAL INFORMATION)I am applying for(Required) 2nd Year 3rd Year Transition Year 5th Year 6th Year Home TelephoneAddress(Required) Street Address Address Line 2 City County / State / Region Eircode Second address (if parents living apart)Second address (if parents living apart) Street Address Address Line 2 City County / State / Region Eircode Home TelephoneFather's detailsFather's name & surname(Required) First Last Mobile(Required)Email Address(Required) Mother's detailsMother's name & surname(Required) First Last Mobile(Required)Email Address(Required) Mother’s maiden name Guardian’s name & surname (if applicable)If student living with guardian Guardian’s name & surname First Last Guardian’s address Street Address City County / State / Region Eircode Email Address Mobile SECTION B – CURRENT SCHOOLCurrent school(Required) Name of Principal(Required) Current Class(Required) School Address(Required) Street Address Address Line 2 City County / State / Region Eircode Learning SupportLearning Support means extra one-to-one or group tuition your son may have received in school.Has your son received any learning support while in school? Yes No If yes, in what area (e.g. Maths, English) and in what classes (e.g. 5th class primary, 1st year secondary) Exceptional AbilityExceptional Ability means any special talents your son may have in particular subjects, for example Math’s, Art, Music, Sport etc.Does your son have exceptional ability in any area? Yes No If yes, in what areas Special Needs Assistant (SNA)Special Needs Assistants are people who help the teacher inside or outside the classroom. They are sometimes appointed to a child on an individual basis (if the child has particular learning, behavioural or physical difficulties).Did your son have an SNA at any stage of his schooling to date? Yes No If yes, in what classes (e.g. 5th class primary) Educational assessmentIf a child is experiencing difficulties with learning, he may be referred to an educational psychologist for an assessment to find out whether he may have specific learning difficulties such as Dyslexia.Was your son ever referred for assessment by an educational psychologist? Yes No If yes, could you forward a copy of any such report(s) to the Principal of Marian College with this form (These reports may be held by the primary school principal or by the psychologist) Other assessmentIf a child is experiencing behavioural difficulties, he may be referred to a doctor or to a clinic (such as the Lucena Child and Adolescent Clinic)Was your son ever referred for a behavioural assessment to a doctor or clinic? Yes No If yes, is he currently attending such a doctor or clinic? Yes No If yes to either of these last questions, could you forward a copy of any such report(s) to the Principal of Marian College with this formIrish languageExemption from the learning of Irish is only granted by the Department of Education & Science if a child (a) has arrived from abroad after the age of 12 or (b) has spent time abroad or (c) Presents with significant learning difficulties This exemption is generally provided by his Irish primary school – please consult Circular 53/2019 @ www.des.ieIs your son already officially exempt from the study of Irish? Yes No If yes, you must forward a copy of the school exemption with this form Nationality questions (see Circular 0023/2016)Was your son born in a country other than Ireland? Yes No If yes, please answer the following questionsDate of arrival in Ireland: DD slash MM slash YYYY Country of birth of student Nationality Nationality of father Nationality of mother Child’s mother tongue (the language a child speaks as their first language) is The Depart of Education and Skills is seeking the following information where the parent opts to provide it. If you consent to provide this information, please tick the ethnic or cultural background to which this pupil belongs: White Irish Roma Black or Black Irish – African Asian or Asian Irish – Chinese Other including mixed background Irish Traveller Any other white background Black or Black Irish – any other Black background Asian or Asian Irish – Any other Asian background If you do not consent to provide this information then please tick “No consent” below No consent Health needsOutline any medical or health related information that we should know about your child Medical cardDoes the student or his parent(s) possess a medical card. Yes No Sports or other clubsOutline any clubs to which your son belongs Please confirm that you are happy for us to contact you by SMS/text message/email & telephone.(Required) YES NO Marian College is a data controller under the Data protection Acts, 1998 & 2003 & GDPR. The personal data supplied is required for the purpose of Student enrolment, student registration, allocation of teachers & resources to the school, determining a student’s eligibility for additional learning supports & transportation examinations, child welfare & to fulfil our other legal obligations. The School maintains a database of photographs of school events held over the years. It has become customary to take photos of students engaged in activities & events. Photographs may be published on our school website or in brochures, yearbooks, newsletters, local & national newspapers & similar school-related productions.Photographs 1. If you are happy to have your child’s photograph taken as part of the school activities & included in all such records, thick here 2. If you would prefer not to have your child’s photograph taken & included in such records, please tick here 3. If you are happy for your child’s photograph to be taken & included, as 1. Above, but would prefer not to have images of your child appear on website, in school brochure’s, yearbooks, newsletter etc. please thick ************************************************************************************I/we wish my/our son to become a student at Marian College for the 2019/2020 academic year. I/we agree that I/we will respect the ethos of the College as a Marist Catholic school. I/we will do my/our best to ensure that my/our son complies with the rules and regulations of the College. I/we consent to the recording by the school of certain sensitive personal data which will be furnished to the Department of Education & Skills in the annual October returns. I/we agree that Marian College may receive on a confidential basis our son’s school reports and any other reports (including psychological reports). I/we also agree that if in the school’s opinion, my/our son should require guidance and counselling that I/we assent to his availing of such services at the College. SIGNED ____________________ Parent/Guardian DATE ____________________ SIGNED ____________________ Parent/Guardian DATE ____________________ (If both parents and/or guardians are available, then each should sign the above).Consent(Required) I agree to respect the ethos of the College as a Marist Catholic school and I agree to abide by the rules and regulations of the College at all times(Required) SIGNED ____________________ Student DATE ____________________ Note: While the information provided will generally be treated as private to Marian College and will be collected & used in compliance with the Data Protection 1998 & 2003, and GDPR, from time to time it may be necessary for us to transfer your personal data on a private basis to other bodies (including the Department of Education & Skills, the department of Social Protection, An Garda siochána, the Health Service Executive, Tusla (CFA), Social Workers or medical practitioners, the national Educational Welfare Board, the National Council for special Education, any Special Education Needs Organiser, the National Educational Psychological Service, or (where the student is transferring to another school). We rely on parents/guardians & students to provide us with accurate & complete information & to update us in relation to any change in the information provided. CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
