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HOME STAY APPLICATION
Applicant’s personal details
Surname
First name
Date of birth
Occupation
Address
Telephone No
Home
Work
Mobile
Email address
Please complete below for each person who resides either full time or part time at your household. Do not
include other overseas students residing on a temporary basis.
1
Surname
Name
Date of birth
Occupation
Relationship to applicant above
Full Time
Time spent at house
2

 Other (specify) 
Weekends
Surname
Name
Date of birth
Occupation
Relationship to applicant above
Full Time
Time spent at house
3

 Other (specify) 
Weekends
Surname
Name
Date of birth
Occupation
Relationship to applicant above
Full Time
Time spent at house
4

 Other (specify) 
Weekends
Surname
Name
Date of birth
Occupation
Relationship to applicant above
Full Time
Time spent at house
5

 Other (specify) 
Weekends
Surname
Name
Date of birth
Occupation
Relationship to applicant above
Full Time
Time spent at house
6

 Other (specify) 
Weekends
Surname
Name
Date of birth
Occupation
Relationship to applicant above
Time spent at house
Full Time

Weekends
 Other (specify) 
International Study Institute reserves the right to seek a Garda check on each household member. Has the applicant or any
member of this household ever been convicted of a criminal offence?
If yes, please give the details.
Yes
 No

____________________________________________________________________________
Please tick the kinds of students you are willing to accept – you may tick as many boxes as you wish.
Adults
(18 years old +)
Adolescents
(13 years old +)
Male

Male

Female

Female

Mature (aged 40+)

Short term (1 – 4 weeks)

Long term (3 months +)

Long term (9 months Sept – June)

Short term (2 – 11 weeks)

With special dietary needs

Couples (married or unmarried)

With special dietary needs

House holds that agree to collect students at the airport when required will always be
given preference. We pay an allowance of Euro 45 towards your costs for this service.
Are you willing to provide this service?
Yes

No 
Do you allow smoking in your house?
Yes

No 
Do you have a back garden?
Yes

No 
Do you have pets which students may be allergic to?
Cat

Do you host students for other schools?
Yes

No

Do you have a living room where the student may mix and interact with members of the
Yes

No

Do you have any musical instruments which students can use?
Yes

No

Is there computer/internet access in your home which students may use?
Yes

No

Do you have house/contents insurance?
Yes

No

Dog

Other 
household?
Bedrooms available:
Single
No
Contents:
Desk

Chair

Wardrobe
Bedside lamp 
Twin
No
Contents:
Desk

Chair

Wardrobe
Bedside lamp 
En-suite
No
Contents:
Desk

Chair

Wardrobe
Bedside lamp 
No Beds 
Location:
What bus route / DART / Luas would students take to get to our (off Capel Street, Dublin city centre) school from your home?
How long would this journey take approx. in morning traffic?
Secondary School Placements:
ISI Ireland also runs a High School Programme, placing international students (aged 13 – 17) into Irish secondary schools for 1 –
3 academic years. Due to the age group and the length of these programmes, households are chosen which have experience in
dealing with teenagers and can provide a high level of care and attention – a home away from home. Would you be interested in
hosting for this programme?
If yes, please give the names of secondary
1.
schools in your area and the bus/ DART/ Luas
2.
which the student would take to them.
3.
4.
5.
Household profile:
Please write a short paragraph introducing your household including the members of your household, your
interests, your hobbies and any other information which will help us in placing a suitable student with you.
Applicant declaration
I have read the Home Stay Guidelines and agree to abide by them. I confirm I have filled out this form
accurately and truthfully. I accept that an Accommodation Officer from ISI Ireland will visit my household
and assess its suitability for hosting student, prior to placing any student with me.
Signed:
Date:
Please return form to:
Accommodation Officer, ISI Ireland, 4 Meetinghouse Lane, Mary’s Abbey, Dublin 7
Fax: 01-8788538 Email: info@isi-ireland.ie
For office use only
Date visited: ___________________________Visited by: ___________________________
Comments: