2024 - 2025 - APPLICATION - “INSTRUMENT AND IMPROVISATION” INTERNSHIP -

NAME *

FIRST NAME *

INSTRUMENT *

Address *

Zip code *

Locality *

Country *

NATIONALITY *

FRENCH
EEA COUNTRIES
COUNTRIES outside the EEA

EEA = European Economic Area

Veuillez préciser *

GENDER *

F
M
Other

DATE OF BIRTH *

LOCATION OF BIRTH *

COUNTRY OF BIRTH *

SOCIAL SECURITY No. *

CELL PHONE *

E-MAIL *

EMERGENCY CONTACT (First name, last name) *

CELL PHONE *

NUMBER OF YEARS OF INSTRUMENTAL PRACTICE *

HAVE YOU FOLLOWED ANY MUSICAL TRAINING? *

TRAINING TITLE *

DURATION OF TRAINING *

NAME OF THE ESTABLISHMENT *

HAVE YOU OBTAINED A DIPLOMA OR CERTIFICATION? *

Yes
Expected to be obtained at the end of the current school year
No

TITLE OF DIPLOMA / CERTIFICATION *

Year of graduation *

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HAVE YOU FOLLOWED ANY OTHER MUSICAL TRAINING? *

TRAINING TITLE *

DURATION OF TRAINING *

NAME OF THE ESTABLISHMENT *

HAVE YOU OBTAINED A DIPLOMA OR CERTIFICATION? *

Yes
Expected to be obtained at the end of the current school year
No

TITLE OF DIPLOMA / CERTIFICATION *

Year of graduation *

HAVE YOU OBTAINED ONE OR MORE GENERAL EDUCATION DIPLOMAS (baccalaureate level or higher) *

DEGREE LEVEL *

State your highest degree

TITLE OF DIPLOMA *

year of graduation *

HAVE YOU EVER HAD ANY PROFESSIONAL ACTIVITIES? *

PROFESSIONAL ACTIVITY *

NUMBER OF CONCERTS OVER THE LAST 3 YEARS *

0 to 5
6 to 14
15 and up

What is your professional activity? *

EMPLOYER *

START DATE *

END DATE *

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ADD ANOTHER PROFESSIONAL ACTIVITY *

OTHER PROFESSIONAL ACTIVITY *

NUMBER OF CONCERTS OVER THE LAST 3 YEARS (copier) *

0 to 5
6 to 14
15 and up

What is your other professional activity? *

EMPLOYER *

START DATE *

END DATE *

How do you plan to finance your training? Yourself (AUTO)? By applying to an organization? *

SELF-FINANCING
AFDAS
OPCO
CR – REGIONAL COUNCIL
POLE EMPLOI
AGEFIPH (handicap)
EMPLOYER
OTHER

Please check your eligibility in advance with the various funding organizations.

If you wish to be financed by an OPCO other than AFDAS, please specify its name *

If you wish to be funded by your employer, please specify their name *

If you wish to be funded by the regional council, please specify which one *

If you wish to be funded by France Travail. Please specify your Pôle Emploi identification number *

Geographical area of the Pôle Emploi *

Please indicate your other source of funding *

REQUEST FOR EXEMPTION FOR CANDIDATES UNDER 18 YEARS OLD TO START TRAINING *

Request for exemption – 18 years to download *