ERASMUS APPLICATION FORM
The present form has to be filled in by the student in capital letters.
Email address *
HEAJ - Cellule Relations internationales - rue Godefroid 32 (2e étage) à 5000 NAMUR - Tél. +3281 24 94 91 - cri@heaj.be
Identity of the student - Last name *
Your answer
First name *
Your answer
Date of birth *
Your answer
Nationality *
Your answer
Sex *
Phone number *
Your answer
Mobile phone *
Your answer
Email address *
Your answer
Address *
Your answer
Period of study *
Department to choose *
Bachelor's degree to choose *
Honours year
If you have selected Computer Graphics, please write below the address of your portfolio.
Your answer
Year of study *
Master
Home University *
Name
Your answer
Home University complete address *
Your answer
Home University Institutional Coordinator's name *
Your answer
Home University Institutional Coordinator's email address *
Your answer
Home University Institutional Coordinator's phone number *
Your answer
I hereby authorize the HEAJ to publish any picture of myself on their website. *
Additional information *
yes
no
Would you like to register to the French course?
Do you have access needs (physical, mental, health-related conditions or learning disabilities)? If yes, we invite you to follow the link below.
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