Ms Mr Address: Age: years Telephone: Date of birth: / / Email: @cnsmdp.fr Nationality: SURNAME and Given Name of Principal Professor: Current course: year of (e.g. Master’s) Discipline: SURNAME and Given Name of Head of Department: Rent for which you are currently responsible in France : Monthly housing allowance received (APL) (if applicable): $/month $/month CROUS Scholarship : Total financial support obtained since 2015 (Conservatoire over 10 months private grant(s), grant(s) from other institutions, etc.) (details $/month on next page): FNAU: $ over 10 months $/month Total annual income before taxes (average salary, pay for temporary work, fees etc. over 12 months): $/month Do you receive financial support from your relatives or others? yes who ?............ no Do you plan to undertake paid work during your time abroad? Parental income before tax (2016 tax assessment based on yes no 2015 income): Parental support or maintenance during your time abroad: $/year $/month Number of dependent children in the parental home: Student loan: yes no Duration of loan: / / to / / Bas du formula Assistance received in 2015 Do you receive a grant from the Conservatoire? yes no Amount per month in $…………………………………………………………………………………………………………… If you are not a French national, do you receive a grant from the French government? yes no
Ms Mr Age: years Date of birth: / / Nationality: Address: Telephone: Email: @cnsmdp.fr SURNAME and Given Name of Principal Professor: SURNAME and Given Name of Head of Department: Current course: year of (e.g. Master’s) Discipline: Rent for which you are currently responsible in France : $/month Monthly housing allowance received (APL) (if applicable): $/month CROUS Scholarship : $/month over 10 months FNAU: $/month over 10 months Total financial support obtained since 2015 (Conservatoire private grant(s), grant(s) from other institutions, etc.) (details on next page): $ Total annual income before taxes (average salary, pay for temporary work, fees etc. over 12 months): $/month Do you plan to undertake paid work during your time abroad? yes no Parental support or maintenance during your time abroad: $/month Student loan: yes no Duration of loan: / / to / / Do you receive financial support from your relatives or others? yes who ?............ no Parental income before tax (2016 tax assessment based on 2015 income): $/year Number of dependent children in the parental home: Bas du formula Assistance received in 2015 Do you receive a grant from the Conservatoire? yes no Amount per month in $…………………………………………………………………………………………………………… If you are not a French national, do you receive a grant from the French government? yes no
SYLFF_2016.docx