Supervised Study Application Form
Term 1 2017 (4th September - 26th October / Mon-Thurs 4:30pm - 7:30pm)

Cost €25/ week or €180/ 8 weeks (with €30 discount on 8 week option if paid before 15th Sept.)
Email address *
Name of Student *
Your answer
Home Address *
Your answer
Home Phone Number
Your answer
School *
Your answer
Year in School *
Parent/Guardian Name *
Your answer
Parent Guardian Contact Number *
Your answer
Any Relevant Medical/ SEN Details
Your answer
Terms and Conditions (please read carefully and discuss with the student before applying) Absenteeism should be kept to a minimum and any absences will be communicated via text. Students must be punctual for each study session and be seated before the roll call. Students must be seated at their assigned desk at all times. Students are not permitted to leave study without prior written permission. Borrowing books/ equipment is forbidden. Communication with other students is not allowed at any time during study. Mobile phones must be turned off and no student is permitted to use earphones etc. The use of school iPads is permitted but students are forbidden from using non-educational resources. If your son/ daughter is not committed to the programme and does not comply with the above terms and conditions, they will be expelled from evening study, without refund. Students are expected to work hard for the entire duration of the study session without correction or guidance from the supervisor. *
By agreeing to these terms and conditions, you are accepting that the participating student will be expelled without refund if they do not comply with the terms and conditions above. Payment in full is required before a student may commence study.
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