Exchange Family Application Form

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TY Europe's Exchange Family Application Form

Please complete this form as comprehensively as possible. Once this form is completed, please complete the student application form from the Apply Online menu.

We recommend completing this form on a PC or laptop, as some of the form components may not be visible on a mobile or table device.

Please note you will need to upload the following documents during the process

  • European Health Card 
  • Letter from School, stating that they accept the student
  • Student Passport ID
  • Junior Cert results or recent school report

So please have these to hand to ease the process.

Student Details

Please enter
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/ / Please enter date
Please enter valid email address
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Would you, the student, like to go First or Second in the exchange?

Please select

For how long, would you the student, want your exchange for? (min 4 weeks)

Please select

Please select

Please select

Please describe the students character and why you think they would be suitable for this exchange in the box provided below?

Please enter
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Has the student ever been away before (exchange visits or school trips)?

Please select
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Health Profile

Vaccinations and childhood illnesses. 

If you are unsure of any of the below questions, your family doctor should have this information.

Vaccinations

Please check the boxes below indiciating which vaccinations the student has received.

Please select at least one
Please enter

Health Questionnaire:

Q1. Has the student already undergone any form of surgery?

Please select
Please enter

Q2. Has the student ever had a general anaesthetic?

Please select
Please enter

Q3. Has the student ever had a local anaesthetic?

Please select
Please enter

Q4. Is the student allergic to any medicines?

Please Select
Please enter

Q5. Does the student have any Food Allergies?

Please select
Please enter

Q6. Has the student ever had an eplieptic fit?

Please select
Please enter

Q7. Is the student asthmatic?

Please select
Please enter

Q8. Does the student have any sleep disorders?

Please select
Please enter

Health Profile cont'd...

Q9. Does the student often get headaches?

Please select
Please enter

Q10. Does the student often get stomach aches?

Please select
Please enter

Q11. Is the student often constipated?

Please select
Please enter

Q12. Does the student have any skin problems?

Please select
Please enter

Q13. Has the student ever suffered from giddiness and/or fainting with a loss of consciousness?

Please select
Please enter

Q14. Does the student suffer from any illness not already mentioned?

Please select
Please enter

Q15. Does the student take regular form of medication?

Please select
Please enter

Q16. Is there any medical reason why the student may not particapte in sport?

Please select
Please enter

Q17. Does the student have any food intolerences?

Please select
Please enter

Miscellaneous remarks - sleep patterns, disabilities, anorexia (now or in the past), car sickness etc?

Please enter

We require a copy of your European Health Card, please upload here.

Please upload copy of the student's E11 Card

Schooling Arrangements

For the present school year:

Please enter
Please enter
Please enter
Please enter valid phone number
Please enter valid website address
Please select from the dropdown

Approximate number of students..

Please enter
Please enter
Please enter
Please enter

Has the school been involved in a language exchange previously?

Please select

Do you give permission for the school to give us a reference?

Please select

We will need written confirmation from the school that they will accept an exchange student. You as the legal guardian of the student are responsible for all school costs and extra-curricular activities.

Please upload letter from school

Please upload a copy of the students Junior Cert results or most recent school report here:

Please upload copy for Junior Cert Results or latest school report

Please upload a copy of the student's passport here:

Please upload copy of the student's passport

Family Concerned

Personal Details

Please enter
Please enter valid phone number

Mothers Details:

Please enter
Please enter
Please select dates
Please enter valid phone number
Please enter valid email address

Do you have any health issues or disabilities?

Please select
Please enter details here

Do you smoke?

Please Select

Occupation:

Please detail occupation/working hours and arrangements if required for child care.

Please enter details here

Fathers Details:

Please enter
Please enter
Please select dates
Please enter valid phone number
Please enter valid email address

Do you have any health issues or disabilites?

Please select
Please enter

Do you smoke?

Please select

Occupation:
Please detail occupation/working hours and arrangements if required for child care.

Please enter

Brothers and Sisters

Please provide details of the student's brothers and sisters, if applicatable in the box below:

Please enter

Do any of the student's siblings have special needs?

Please select
Please enter details:

Does the student's biological mother or father live in the family home?

Please select

If the biological mother or father does not live in the family home please complete the following details relevant to the students mother or father:

Please enter details:
Please enter details:
Please enter date

How often do they see the student and under what circumstances?

Please enter details:

Do you live in a:

Please select
Please enter

Would the exchange student have to share a room with the student concerned? (Select no if they have the option to have their own room.)

Please select

Do you ever, whatever the reason, allow your children to leave the family home unaccompanied either during the day or at night?

Please select
Please enter

Home Environment

Please answer the following questions, and set out general rules and behaviour expected within the family.

If a student is to adapt to a new family we will need to know about their family's ideas on education, their daily habits and their expectations.

Are your children free to watch as much television as they want or do you monitor what they watch and how much? How many hours per day/per week?

Please enter details

For how long are they allowed to use their tablet/computer or games console? Do you have rules around access to the internet and are devices allowed in the bedroom overnight?

Please enter

Are the children expected to help with the household chores?

Please select
Please enter details

Do you allow your children to travel independently?

Please select
Please enter details

Do you allow your children to be driven by others?

Please select
Please enter details

Do you allow your children to stay in the family home alone either by day or night?

Please select
Please enter details

Do you have Pets?

Please select
Please enter details

Will there be any other students in the house at the same time as the exchange student?

Please select
Please enter details

What do you like to do as a family in your free time and at the weekends?

Please enter details

What activities, sports and outings are you proposing to offer your student?

Please enter

What sort of exchange family do you have in mind for your child?

Please enter

Please tell us about other family members, their relationship with your children and family (especially the student concerned)

Please enter

References

Please give details of two families (or people) who know your child and the family well but who are not related to you. We will contact these families for a reference. Please provide their name and email address below:

Please enter
Please enter
Please enter valid email address
Please enter valid email addess

Vetting 

The Provision of the Children Act 1991 requires Host Families to complete the declaration questions (below) regarding suitability to host a TY Europe Ltd student who is under the age of 18 years of age.

All adults over the age of 18, who live in the family home will need to complete a vetting form. The vetting form will be emailed to you after submission of this form.

 

Have you or any member of your family who still lives at home:

Been convicted of any offence against a child?

Please select one

Had a child removed from your care by order of any court?

Please select one

Had a child removed from your home by any other agency?

Please select one

Had your rights and duties with respect to any child vested in a Local Authority?

Please select one

I declare that I have no criminal record or court case pending against me, and there is no reason why I should not be considered a person suitable to work with children.

Please tick

Data Privacy Agreement:

  1. In the course of running our business TY Europe gathers, stores, uses and shares information about our clients with Key Partners & Coordinators who assist with Exchanges and Home Stay Placements;
  1. Personal data is only collected or processed if you give this information voluntarily within the scope of an application request. TY Europe only shares your application information with these parties on a limited basis following due diligence and in accordance with our internal procedures. TY Europe does not share your personal information with any other third parties for their marketing purposes.   In accordance with “Data Protection Regulations” you may request at any tie full details of what personal data has been stored by TY Europe and request that this information be erased.
  1. TY Europe collects and uses your personal data for the following reasons;
  • To provide and operate this service, together with our key partners and coordinators to respond to individual needs.
  • To improve and receive feedback on the website.
  • To improve customer services and to provide support services.
  1. The security of your personal information is exceptionally important to all of us and we use security technology to help protect your personal information from unauthorised access, use or disclosure. TY Europe only shares your personal information via email with the Agents (see Point 1. Above) on the basis that anyone to whom we pass it on protects it in the same way we would and in accordance with applicable laws.
  1. You have rights under “The General Data Protection Regulation” (GDPR) which include:
    1. The right to access personal information that we hold.
    2. The right to have inaccuracies corrected.
    3. The right to object to direct marketing.
    4. The right to have your personal information sent directly to yourself or another organisation.
    5. Rights in relation to automated decision making and profiling.

By marking the following checkbox you agree that TY Europe and our Key Partners collect data for the purposes stated in Point 3. Above and as described in our privacy policy.

I confirm that I have read, consent and agree to TY Europe Data Processing Agreement.

Remember you can always contact us to modify your data, as stated in Point No. 5.

Please tick to proceed

How did you hear about TY Europe Ltd

Please enter

Following your exchange would you be happy to be contacted by other families who are thinking about doing a similar exchange?

Please select one

Almost there!

Thank you for taking the time to complete this form. Once you click Send Form below, you will submit all this information to TY Europe and you will receive a copy of these details and all attched files. 

The next steps will be displayed after you click Send Form.

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