Application Form

Please note that any scholarship request will imply the parents to provide all official documents about their patrimony and revenues.

This application is only possible for students having received a personal code following a successful audition.

Mosa Education Program

Personal Successful Audition Code *

Education Program

Identification information

First Name *

Last Name *

Gender *

Male

Female

Birth Date *

ID/Passport Student *

Validity Date *

ID/Passport Country *

Email *

Phone *

Street and Number *

Postal Code *

City *

Country *

ID/Passport of a Parent/Tutor *

Validity Date *

Full Name of Father

Email of Father

Phone of Father

Full Name of Mother

Email of Mother

Phone of Mother

Full Name of Guardian

Email of Guardian

Phone of Guardian

Tuition Fee

Applicable Tuition Fee (must be consistent with the student's nationality) *

Hosting

Hosting Preferences *

Request for a Hosting Family during Week-ends and Holidays (EUR 15 per night - about EUR 1.200 per School Year)

Scholarship

Scholarship Request (EUR 100 file costs refunded in case of acceptance)

Is your Application Conditioned to the Receipt of a Scholarship? *

Yes

Academic Studies

Do you wish to follow academic studies independently of the Athénée Charles Rogier - Liège 1 (only possible for 16+, under conditions)? *

Yes

To be filled for Students NOT following academic studies at Athénée Charles Rogier - Liège 1

Which academic program will you follow?

To be filled for Students following academic studies at Athénée Charles Rogier - Liège 1

Birth certificate is only mandatory for those studying out of Belgium. Their school reports and birth certificate must all be translated by a sworn translator if the originals are not in one of the following languages: French, Dutch, German, English, Italian, Spanish (Castilian) or Portuguese.

End-of-year school reports from the previous two years

Current year last school report

Birth certificate

Other information

French level *

Beginner

Elementary

Intermediate

Advanced or better

Remarks/Additional Info

Please check this box to confirm your engagement for which you declare to be informed of the invoicing schedule of the selected services *

Job

Department

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