Simply print the Form, complete it and post to St. Laurence College, Loughlinstown, Dublin 18.
(Click Here to Return to Repeat Leaving Certificate Information page.)

SEVENTH YEAR APPLICATION FORM
2010/2011

Name: _____________________________________ P.P.S. number: __________________

Address: ___________________________________ Date of birth: ____________________

__________________________________________ C.A.O. number: __________________

__________________________________________ Candidate mobile: _________________


Contact landline: _______________________ School(s) attended: _________________________

Mother’s Name: _________________________ Occupation: ____________________________

Father’s Name: __________________________ Occupation: ____________________________

Parent/guardian contact number(s) __________________________________________________

Parent/guardian email address: _____________________________________________________

 

Leaving Certificate year: ___________ Leaving Certificate points: _____________

HPAT: _____________

Subject

Grade

Level
     
     
     
     
 

Subject

Grade

Level
     
     
     
     


C.A.O. options 2009/10

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

____________________________________________________________________________

 

 

 

Have you ever been assessed/diagnosed with Learning Difficulties? Y/N

If Yes, please give details: _____________________________________________________________

__________________________________________________________________________________

Are you exempt from Irish? NUI / DES

If Yes, please give details: _____________________________________________________________

Interests / Extra - curricular activities in your previous school/outside school

___________________________________________________________________________________

_________________________________________________________________________

 

_________________________________________________________________________

 

We appreciate that this is a provisional application. With that limitation, indicate your reasons for considering joining the Repeat Programme at St. Laurence College.

______________________________________________________________________________________

___________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

 

Signature of candidate: ______________________________ Date: ______________________

Please note:

(1) There is a €75 charge for the interview. This is non-refundable. Should a place on the Programme be offered, this amount will be deducted from the overall charge.

(2)The Application Form must be fully completed before any applicant will be called for interview.

(3) Applicants are required to be dressed appropriately for an interview. (Smart/casual)