Covid-19 Accommodation Declaration Form - Atlantic Centre of Education

In order to control the spread of Covid-19, international students must complete the following form to confirm that they are staying in appropriate accommodation for the duration of their time in Ireland.

This information on this form may be accessed by the Department of Health and the Department of Further and Higher Education, Research, Innovation and Science to ensure that correct Covid-19 protocols are being followed.

Covid-19 Accommodation Declaration Form

Full Name *

Address *

Move in Date

How Long will you be Staying at this Address *

Number of People Staying at This Address *

Number of People Sharing your Room *

I have read, understood and agreed to abide by current government guidelines.

Yes

I will not stay in accommodation that is overcrowded, unsafe or unhygienic.

Yes

I will not share a room with more than one person.

Yes

I agree to resubmit this form and provide my school with my new accommodation details if I change address.

Yes

I confirm that the above information is correct. I agree that my data may be used to contact me to verify the provided information and that it may be used for the purposes of contact tracing in relation to confirmed or suspected cases of Covid-19. Your personal data will be treated with utmost care and will never be shared with third parties unless for the purposes specified above.

Yes

Date

I consent to the use of my details for the purpose of processing this form.

Yes