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Request for financial support from the APEEE Social Fund

Name of student/class/section OR school community member
Name of applicant parent (if beneficiary is a student)
Your email address
Situation familiale (marié(e)/partenariat enregistré/parent isolé(e)/autre (veuillez préciser))
Please specify your family situation!
Please specify your function
Please specify you other professional activity
Monthly net income, including any family allowances and alimony (in EUR)
Monthly rent or mortgage payment (in EUR)
Monthly loan payments (in EUR)
Please provide details if relevant
Veuillez sélectionner une ou plusieurs des options suivantes.
Supporting financial or other personal information (please indicate the supporting documents which you are attaching to this request)
Maximum 3 files.
5 MB limit.
Allowed types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit svg tar zip.
Detailed reason and circumstances justifying the application

The undersigned accepts that the personal information provided herein will be used for the purposes of assessing the request, subject to applicable confidentiality and data protection rules. All documents or information provided by the applicant are to be treated in a confidential manner and returned back or destroyed immediately after the assessment of the request. 

The undersigned accepts that financial assistance granted on the basis of false declarations will be claimed back. All expenses for the recovery of the amount will be charged to him/her.