Kolbe Special School
Admissions Enquiry Form
Pupil’s Details
Child’s Name: ________________________________________________________________
Address: ___________________________________________________________________
__________________________________________________________________________
______________________________________________ Eircode: ___________________
Date of Birth: _____________________
Child’s diagnosed medical condition: _______________________________________________
__________________________________________________________________________
__________________________________________________________________________
By whom: _________________________________ Date: _________________________
Parent’s Details
Father’s Name ________________________ Mother’s Name _________________________
Mobile _________________________ _________________________
Home telephone number __________________________
Note: This application must have a recent Psychological Assessment attached and must state that your child
has a severe/profound general learning disability.
Failure to have a psychological assessment attached means that this application cannot be processed.
Admissions Enquiry Form
Pupil’s Details
Child’s Name: ________________________________________________________________
Address: ___________________________________________________________________
__________________________________________________________________________
______________________________________________ Eircode: ___________________
Date of Birth: _____________________
Child’s diagnosed medical condition: _______________________________________________
__________________________________________________________________________
__________________________________________________________________________
By whom: _________________________________ Date: _________________________
Parent’s Details
Father’s Name ________________________ Mother’s Name _________________________
Mobile _________________________ _________________________
Home telephone number __________________________
Note: This application must have a recent Psychological Assessment attached and must state that your child
has a severe/profound general learning disability.
Failure to have a psychological assessment attached means that this application cannot be processed.