5th Year Application Form 2022/2023

PLEASE COMPLETE ALL QUESTIONS BELOW.
ALL OF THE INFORMATION PROVIDED WILL BE CONFIDENTIAL AND TREATED WITH UTMOST DISCRETION

STUDENT DETAILS

Surname*

Name*

Date of Birth*

Postal Address*

all correspondence will be sent to below address

Eircode*

Student Mobile*

Student Email*

Enter Email Confirm Email

Are You on Facebook?*

If no, please confirm that you will set up a Facebook account immediately*

Yes

PARENT DETAILS

Surname*

Name*

Email*

Regular emails / newsletters / correspondence will be emailed to this address

Enter Email Confirm Email

Mobile*

Back Up Contact Name and Number*

(in the event of us being unable to contact above parent)

We have read EF Parent and Student Pack including the EF Privacy Policy and agree to be bound by it*

Yes

STUDENT WELL-BEING

(to be completed by PARENT only)

Does your child suffer from a medical condition or learning challenge or is currently undergoing evaluation for same?*

(Medical conditions include Asthma, Diabetes, Epilepsy, peanut allergy etc. Learning challenges include dyslexia, dyspraxia, ADHD etc)

If YES, please provide us with the details below*

Is there any other information that you feel is relevant to your child’s well-being?*

(ie bullying / confidence issues / recent school move and why / personal family issues etc )

If YES, please provide us with the details below*

STUDENT STUDY PROFILE

(to be completed by PARENT only)

Please give us a description of your child’s ability in French*

(ie has your child a natural ability for languages / does your child dislike French and if so, why?)

Please give us a description of your child’s work ethic when it comes to general study*

(ie does your child need to be pushed / does your child work on their own initiative etc)

ACADEMIC RECORD

School*

Name of French Teacher*

Why have you chosen to attend Essential French 5th Year programme this year?*

What is your weakest area in French?*

What is your strongest area in French?*

Grade of Junior Cert French exam?*

(indicate Higher”H” or Ordinary “O” paper)

Did you do Transition Year?*

Grade of TY summer French exam*

Have you attended Essential French before?*

If YES, please provide us with details*

Have you any brothers /sisters who are studying French in secondary school from Sept. 2022?*

We will inform you of any French workshops we are running during the academic year that may be suitable for family members

Name / School / Year of these family members*

PAYMENT OPTIONS

Which payment option have you chosen for your child ?*

Option A
Option B
Option C

NEW STUDENT ONLY

Do you have brothers or sisters who attended Essential French before?*

Yes
No

Give Details - Name and Programme(s) Attended*

Please give name and details (a phone number or an email address) of the person who recommended Essential French to you – specify ONE name only (it can not be your own parent’s name)*

Provided you start the programme, the person you name above will receive a €30 Mahon Point Shopping Voucher for recommending us to you, as a “petit merci”