Bruce College Full Time School Application Form

SECTION 1: Student Details

Student First Name:

Completed Form

true

Student Last Name:

Student Preferred First Name:

Student Email:

Student Mobile Number:

Student PPS Number:

(For State Examination Submission)

Gender:

FemaleMale

Date of Birth:

Click to select from calendar.

Country of Birth:

Address/Eircode Lookup:

Address Line 1:

Address Line 2:

Town/City:

County:

Eircode:

Country:

SECTION 2: Parent/Guardian Details

Primary Parent/Guardian First Name:

Primary Parent/Guardian Last Name:

Relationship to student:

MotherFatherGuardian

Primary Parent/Guardian Email Address:

Please ensure that this email is unique to the Primary Contact and not the same as the Student.

Primary Parent/Guardian Mobile Phone Number Prefix:

Primary Parent/Guardian Mobile Number:

Primary Parent/Guardian Address:

Same as studentDifferent from student

If different from student:

Address/Eircode Lookup:

Address Line 1:

Address Line 2:

Town/City:

County:

Eircode:

Country:

SECTION 3: Secondary Parent/Guardian Details

Secondary Parent/Guardian First Name:

Secondary Parent/Guardian Last Name:

Relationship to student:

MotherFatherGuardian

Secondary Parent/Guardian Email Address:

Please ensure that this email is unique to the Secondary Contact and not the same as the Student or Primary Contact.

Secondary Parent/Guardian Mobile Phone Number Prefix:

Secondary Parent/Guardian Mobile Number:

Secondary Parent/Guardian Address:

Same as studentDifferent from student

If different from student:

Address/Eircode Lookup:

Secondary Parent/Guardian Address Line 1:

Secondary Parent/Guardian Address Line 2:

Secondary Parent/Guardian Town/City:

Secondary Parent/Guardian County:

Secondary Parent/Guardian Eircode:

Country:

SECTION 4: Education Details

Current Year:

3rd Year4th Year5th Year6th Year

Year Applying For:

5th Year6th Year6th Year (Repeat)

For Academic Year:

Current School Attending:

Date From:

Click to select from calendar.

Date To:

Click to select from calendar.

Details of other secondary school attended (where applicable):

Date From:

Click to select from calendar.

Date To:

Click to select from calendar.

Reason For Changing Schools Now:

Attendance Record:

Please Indicate days absent from school in the last 12 months.

Reason For Absence:

Has Student Been Suspended or Expelled?:

YesNo

Reason For Suspension or Expulsion:

Student's Specific Educational Requirements:

Has Student Undergone Medical/Psychological Evaluation?:

YesNo

Medical Report

Please attach the student's most recent Educational Psychological Report.

Has Student Specific Medical Health Requirements? Please Detail Below:

SECTION 5: Additional Information

Has Student Any Siblings Currently Enroled in Bruce College Full Time School?

Has Student Any Notable Academic Achievements?

SECTION 6: School Reports

Most Recent School Report:

Please attach the student's most recent school report on school headed paper.

Junior Cycle Results:

Please attach the student's Junior Cycle results (where applicable).

Mock Results:

Please attach the student's Mock Results (where applicable).

Exemptions & Reasonable Accommodation Certificates:

Please attach the student's relevant Certificates (where applicable).

SECTION 7: Payment Method

Preferred Payment Plan For Fees:

Payment Option A: Pay in full before AugustPayment Option B: Two Part Payment - 50% in August & 50% in OctoberPayment Option C: 6 monthly instalments by direct debit from 30th August to 30th January

SIGN OFF:

I/We confirm that all the information provided above to Bruce College is true & accurate. I/We understand that failure to provide accurate information may impact on this application. I/We the parent(s)/guardian(s) undertake to pay all fees to Bruce College after the students place has been confirmed.

I Agree

View Our Admissions Policy