September 2022 – May 2023 Download Form Thank you for your enquiry. We'll be in touch with you shortly. Error while submitting the form. Please try again. Which programme is your school interested in? * Road to Resilience Building Resilience Both School Details School Name* School Address* Address Line 2* City / Town* County* Please choose Counties Antrim Armagh Carlow Cavan Clare Cork Donegal Down Dublin Fermanagh Galway Kerry Kildare Kilkenny Laois Leitrim Limerick Londonderry Longford Louth Mayo Meath Monaghan Offaly Roscommon Sligo Tipperary Tyrone Waterford Westmeath Wexford Wicklow Eircode* School Phone Number* Principal's Name* Has your school been designated as disadvantaged? * Yes No Does your school have any half days? * Yes No If yes, specify which days? School Contact School Contact Name* Position at school* Email* Phone Number* School Programme Has your school previously received the Resilience Academy Programme? * Yes No Road to Resilience Please tick which year groups you will be delivering the Road to Resilience to: Please tick which year groups you will be delivering the Road to Resilience to: - 1st Years Please tick which year groups you will be delivering the Road to Resilience to: - 2nd Years Please tick which year groups you will be delivering the Road to Resilience to: - 3rd Years Please indicate how many students you will be delivering the Road to Resilience to? Please indicate how many students you will be delivering the Road to Resilience to? - Number of 1st Years:* Please indicate how many students you will be delivering the Road to Resilience to? - Number of 2nd Years:* Please indicate how many students you will be delivering the Road to Resilience to? - Number of 3rd Years:* Please indicate how many students you will be delivering the Road to Resilience to? - Gender* Please choose Gender Male Female Mixed Building Resilience Please tick which year groups you will be delivering Building Resilience to: Please tick which year groups you will be delivering Building Resilience to: - 1st Years Please tick which year groups you will be delivering Building Resilience to: - 2nd Years Please tick which year groups you will be delivering Building Resilience to: - 3rd Years Please tick which year groups you will be delivering Building Resilience to: - Transition Years Please tick which year groups you will be delivering Building Resilience to: - 5th Years Please tick which year groups you will be delivering Building Resilience to: - 6th Years Please tick which year groups you will be delivering Building Resilience to: - Leaving Certificate Applied Years Please indicate how many students you will be delivering Building Resilience to? Please indicate how many students you will be delivering Building Resilience to? - Number of 1st Years:* Please indicate how many students you will be delivering Building Resilience to? - Number of 2nd Years:* Please indicate how many students you will be delivering Building Resilience to? - Number of 3rd Years:* Please indicate how many students you will be delivering Building Resilience to? - Number of TYs:* Please indicate how many students you will be delivering Building Resilience to? - Number of 5th Years:* Please indicate how many students you will be delivering Building Resilience to? - Number of 6th Years:* Please indicate how many students you will be delivering Building Resilience to? - Number of LCAs:* Please indicate how many students you will be delivering Building Resilience to? - Gender* Please choose Gender Male Female Mixed Do any students have any special needs? Yes No If yes, please provide more details Are there any issues that we should be aware of? E.g. bullying, self-harm, gender transitioning * Yes No How many teachers will delivering the programme?*