{"id":8860,"date":"2020-06-23T23:34:52","date_gmt":"2020-06-23T21:34:52","guid":{"rendered":"https:\/\/www.accompagner.be\/?page_id=8860"},"modified":"2025-04-02T16:52:21","modified_gmt":"2025-04-02T14:52:21","slug":"demander-un-accompagnement","status":"publish","type":"page","link":"https:\/\/accompagner.be\/fr\/demander-un-accompagnement\/","title":{"rendered":"Formulaire de demande d&rsquo;accompagnement ambulatoire"},"content":{"rendered":"\n<div><u>U kunt dit formulier in<\/u>\n<div class=\"wpml-ls-statics-footer wpml-ls wpml-ls-legacy-list-horizontal\">\n\t<ul><li class=\"wpml-ls-slot-footer wpml-ls-item wpml-ls-item-nl wpml-ls-first-item wpml-ls-item-legacy-list-horizontal\">\n\t\t\t\t<a href=\"https:\/\/accompagner.be\/nl\/\" class=\"wpml-ls-link\">\n                    <span class=\"wpml-ls-native\" lang=\"nl\">Nederlands<\/span><\/a>\n\t\t\t<\/li><li class=\"wpml-ls-slot-footer wpml-ls-item wpml-ls-item-en wpml-ls-last-item wpml-ls-item-legacy-list-horizontal\">\n\t\t\t\t<a href=\"https:\/\/accompagner.be\/en\/\" class=\"wpml-ls-link\">\n                    <span class=\"wpml-ls-native\" lang=\"en\">English<\/span><\/a>\n\t\t\t<\/li><\/ul>\n<\/div>\n<u>invullen.<\/u><\/div>\n\n\n\n<h5 id=\"informations-utiles-avant-de-completer-le-formulaire--ed887612-cd88-4235-bcea-f502a4d3e6f4\">Informations utiles avant de compl\u00e9ter le formulaire :<\/h5>\n\n\n\n<ul><li>Les champs obligatoires marqu\u00e9s d&rsquo;un <span style=\"color:#cf2e2e\" class=\"tadv-color\">*<\/span> contiennent des donn\u00e9es indispensables \u00e0 l&rsquo;ouverture du dossier et au bon d\u00e9roulement de l&rsquo;accompagnement<\/li><li>Introduire la demande une semaine avant la date de l&rsquo;accompagnement. De pr\u00e9f\u00e9rence, pr\u00e9voyez des accompagnements entre de 8h30 et 17h00<\/li><li><strong>Attention<\/strong> : pour que notre mail de confirmation n&rsquo;atterrisse pas dans vos spams, veillez enregistrer notre adresse <a href=\"mailto:info.saa@accompagner.be\">info.saa@accompagner.be<\/a> dans votre carnet d&rsquo;adresses<\/li><li>Pour plus d&rsquo;information, contactez-nous <strong>02.580.20.33<\/strong> (de 9h \u00e0 16h)<\/li><\/ul>\n\n\n\n\n\n\n\n<div class=\"wp-block-columns has-pale-cyan-blue-background-color has-background\">\n<div class=\"wp-block-column is-vertically-aligned-bottom\" style=\"flex-basis:100%\">\n<div class=\"wp-block-columns\">\n<div class=\"wp-block-column\">\n<div class=\"wp-block-columns\">\n<div class=\"wp-block-column\" style=\"flex-basis:75%\">\n<h5 id=\"conditions-generales-de-collaboration-04bd030d-7a9f-45d0-b59b-29dc9f3dc8f1\"><strong><a href=\"https:\/\/accompagner.be\/wp-content\/uploads\/FORPARCGC_Conditions_generales_collaboration_2023_FR.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Conditions g\u00e9n\u00e9rales de collaboration<\/a><\/strong><\/h5>\n<\/div>\n\n\n\n<div class=\"wp-block-column\" style=\"flex-basis:25%\">\n<div class=\"wp-block-image\"><figure class=\"alignright size-large is-resized\"><a href=\"https:\/\/accompagner.be\/wp-content\/uploads\/Conditions-Generales-Collaboration_Accompagner.pdf\" target=\"_blank\" rel=\"noopener\"><img loading=\"lazy\" src=\"https:\/\/accompagner.be\/wp-content\/uploads\/download-logo.png\" alt=\"\" class=\"wp-image-11850\" width=\"117\" height=\"48\"\/><\/a><\/figure><\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-column\">\n<div class=\"wp-block-columns\">\n<div class=\"wp-block-column\" style=\"flex-basis:75%\">\n<h5 class=\"has-text-align-center\" id=\"clause-de-soustraitance-rgpd-84d538fb-0ed6-45b0-8eac-3b63154af7a8\"><a href=\"https:\/\/accompagner.be\/wp-content\/uploads\/Clauses-de-sous-traitance.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Clause de Sous-traitance (RGPD)<\/strong><\/a><\/h5>\n<\/div>\n\n\n\n<div class=\"wp-block-column\" style=\"flex-basis:25%\">\n<figure class=\"wp-block-image size-large is-resized\"><a href=\"https:\/\/accompagner.be\/wp-content\/uploads\/Clauses-de-sous-traitance.pdf\" target=\"_blank\" rel=\"noopener\"><img loading=\"lazy\" src=\"https:\/\/accompagner.be\/wp-content\/uploads\/download-logo.png\" alt=\"\" class=\"wp-image-11850\" width=\"117\" height=\"48\"\/><\/a><\/figure>\n<\/div>\n<\/div>\n\n\n\n<p><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-advgb-columns advgb-columns-wrapper\" id=\"advgb-cols-68554326-c1d5-439b-9c2a-f3b0a08f6b55\"><div class=\"advgb-columns-container\"><div class=\"advgb-columns advgb-columns-row advgb-is-mobile advgb-columns-2 layout-12-12 mbl-layout-stacked gutter-10 vgutter-10\">\n<div class=\"wp-block-advgb-column advgb-column advgb-is-half-tablet advgb-is-full-mobile\" id=\"advgb-col-b7e940c2-61b4-4c64-9b00-d90b8543593c\"><div class=\"advgb-column-inner\" style=\"border-style:none;border-color:#0693e3;border-width:1px\">\n<div class=\"wp-block-advgb-columns advgb-columns-wrapper resizable box-solid-blue\" id=\"advgb-cols-2f226021-3a32-45b8-bb58-da93a37bb737\"><div class=\"advgb-columns-container\"><div class=\"advgb-columns advgb-columns-row advgb-is-mobile advgb-columns-1 layout-100 mbl-layout-stacked vgutter-10\" style=\"min-height:200px;max-height:200px\">\n<div class=\"wp-block-advgb-column advgb-column advgb-is-full-mobile\" id=\"advgb-col-1c5e4952-6231-42b1-bc14-35cfdd0c26c9\"><div class=\"advgb-column-inner\" style=\"border-style:none;border-color:#0693e3;border-width:1px\">\n<p><strong>Service d\u2019Accompagnement Ambulatoire (SAA)<\/strong><\/p>\n\n\n\n<p><strong>Conditions G\u00e9n\u00e9rales de Collaboration<\/strong><\/p>\n\n\n\n<p><strong><u>Introduction<\/u><\/strong><\/p>\n\n\n\n<p>Le SAA propose ses accompagnements ambulatoires &#8211; ou \u00ab accompagnements de terrain&nbsp;\u00bb &#8211; aux associations et organisations priv\u00e9es ou publiques (les \u00ab&nbsp;partenaires&nbsp;\u00bb) n\u2019ayant pas la possibilit\u00e9 de les organiser elles-m\u00eames pour leurs usagers, et permet ainsi d\u2019accroitre l\u2019efficacit\u00e9 de leur action. Ces accompagnements sont effectu\u00e9s par ses volontaires, form\u00e9s \u00e0 cet effet, sur base d\u2019un \u00ab&nbsp;ordre de mission&nbsp;\u00bb&nbsp;compl\u00e9t\u00e9 \u00e0 partir de la demande effectu\u00e9e par le partenaire.<\/p>\n\n\n\n<ol><li><strong><u>Dans quel esprit travaillons-nous&nbsp;?<\/u><\/strong><\/li><\/ol>\n\n\n\n<ul><li>Pour faire sa demande d\u2019accompagnement de terrain, le partenaire doit en avoir d\u00e9termin\u00e9 le besoin et la n\u00e9cessit\u00e9 ainsi que le degr\u00e9 d\u2019autonomie de l\u2019usager, afin de pouvoir mieux fixer le r\u00f4le de l\u2019accompagnant.<\/li><li>L\u2019usager doit savoir pourquoi il est accompagn\u00e9. Il doit \u00eatre partie prenante de sa d\u00e9marche et de son accompagnement.<\/li><li>Le SAA s\u2019occupe du suivi de l\u2019usager le temps de la d\u00e9marche. Il peut interroger le partenaire afin de bien comprendre l\u2019objectif de l\u2019accompagnement.<\/li><li>Toute personne traitant la demande au sein des Amis d\u2019Accompagner est tenue au secret professionnel.<\/li><li>Diff\u00e9rents types de missions peuvent \u00eatre demand\u00e9s: aide administrative, soutien moral, soutien linguistique, trajet entre diff\u00e9rents organismes, visite de logements, soutien actif lors de d\u00e9marches plus lourdes, etc.<\/li><li>Les accompagnements de type&nbsp;\u00ab&nbsp;courses, tris de documents \u00e0 domicile, promenades, activit\u00e9s sportives ou r\u00e9cr\u00e9atives, etc.&nbsp;\u00bb n\u2019entrent pas dans le cadre de notre mission et ne sont pas pris en charge.<\/li><li>Introduire une demande d\u2019accompagnement n\u2019est pas une garantie de prise en charge de la demande&nbsp;: nos accompagnements de terrain d\u00e9pendent de la disponibilit\u00e9 de nos volontaires. \u00c0 chaque fois n\u00e9anmoins, une communication du SAA suivra la demande d\u2019accompagnement.<\/li><li>Notre service est gratuit. Nos accompagnements se r\u00e9alisent uniquement en transport public.<\/li><li>Nos volontaires sont en majorit\u00e9 bruxellois, la d\u00e9marche \u00e0 r\u00e9aliser sera en R\u00e9gion bruxelloise ou \u00e0 partir de Bruxelles.<\/li><li>Nos accompagnements s\u2019effectuent normalement durant les heures d\u2019ouverture des bureaux (8h-17h) pour permettre \u00e0 nos volontaires d\u2019avoir un relais.<\/li><\/ul>\n\n\n\n<ol start=\"2\"><li><strong><u>Pr\u00e9parer l\u2019accompagnement de terrain<\/u><\/strong><\/li><\/ol>\n\n\n\n<p>Avant d\u2019introduire la demande d\u2019accompagnement, le partenaire demandeur doit&nbsp;:<\/p>\n\n\n\n<ul><li>V\u00e9rifier les horaires d\u2019ouverture et\/ou obtenir un rendez-vous aupr\u00e8s du service aupr\u00e8s duquel va se r\u00e9aliser l\u2019accompagnement.<\/li><li>Convenir de la date et de l\u2019heure avec l\u2019usager et les lui rappeler la veille de l\u2019accompagnement.<\/li><li>Pr\u00e9parer le dossier que l\u2019usager doit avoir avec lui, et au besoin lui rappeler de n\u2019oublier aucun document susceptible de favoriser la d\u00e9marche \u00e0 entreprendre en accompagnement.<\/li><li>Informer l\u2019usager que les informations de sa situation et de sa d\u00e9marche sont aussi connues du SAA.<\/li><\/ul>\n\n\n\n<ol start=\"3\"><li><strong><u>Compl\u00e9ter le formulaire de demande d\u2019accompagnement<\/u><\/strong><\/li><\/ol>\n\n\n\n<ul><li>Compl\u00e9ter la demande d\u2019accompagnement via le formulaire en ligne&nbsp;: <a href=\"http:\/\/www.accompagner.be\/fr\/demander-un-accompagnement\">www.accompagner.be\/fr\/demander-un-accompagnement<\/a>.<\/li><li>D\u00e9velopper et d\u00e9tailler la d\u00e9marche \u00e0 r\u00e9aliser pour permettre de comprendre le besoin de l\u2019usager, la raison de l\u2019accompagnement et la d\u00e9marche en cours.<\/li><li>Envoyer la demande au plus tard 3-4 jours ouvrables avant la date de l\u2019accompagnement. En cas de d\u00e9lai plus court, il convient de t\u00e9l\u00e9phoner avant de compl\u00e9ter le formulaire (02\/580.20.33).<\/li><li>Indiquer explicitement les informations susceptibles d\u2019influencer le d\u00e9roulement de la d\u00e9marche (ex&nbsp;: l\u2019usager pr\u00e9f\u00e8re ne pas \u00eatre touch\u00e9, se d\u00e9place en fauteuil roulant\/rollator, etc.).<\/li><li>Contacter le SAA avant de compl\u00e9ter le formulaire en ligne lorsqu\u2019il s\u2019agit d\u2019un accompagnement d\u2019urgence ou d\u2019une demande plus particuli\u00e8re comme l\u2019accompagnement de mineur d\u2019\u00e2ge, la traduction d\u2019une langue peu courante, etc.<\/li><\/ul>\n\n\n\n<ol start=\"4\"><li><strong><u>Confirmation de l\u2019accompagnement<\/u><\/strong><\/li><\/ol>\n\n\n\n<ul><li>Apr\u00e8s l\u2019envoi du formulaire, un message automatique de confirmation de la r\u00e9ception de la demande est envoy\u00e9 au partenaire demandeur.<\/li><li>D\u00e8s qu\u2019il a pu \u00eatre confi\u00e9 \u00e0 un volontaire, l\u2019accompagnement lui est confirm\u00e9 par mail.<\/li><li>Le partenaire demandeur pr\u00e9vient l\u2019usager qu\u2019il sera bien accompagn\u00e9 par un volontaire. Il lui rappelle \u00e9galement les heures et lieux de rendez-vous.<\/li><li>Si le partenaire demandeur n\u2019a pas re\u00e7u de mail de confirmation, il t\u00e9l\u00e9phone au SAA (02\/580.20.33) pour s\u2019informer des suites donn\u00e9es \u00e0 sa demande<a href=\"#_ftn1\"><sup>[1]<\/sup><\/a>.<\/li><\/ul>\n\n\n\n<ol start=\"5\"><li><strong><u>Ajustement de la demande d\u00e9j\u00e0 envoy\u00e9e<\/u><\/strong><\/li><\/ol>\n\n\n\n<ul><li>Si une modification doit \u00eatre apport\u00e9e \u00e0 une demande d\u00e9j\u00e0 introduite, il convient de contacter sans d\u00e9lai le SAA (02\/580.20.33 ou <a href=\"mailto:info.saa@accompagner.be\">info.saa@accompagner.be<\/a>).<\/li><li>Si le partenaire demandeur n\u2019est pas joignable entre le moment de la demande et le moment de l\u2019accompagnement, il s\u2019assure qu\u2019une autre personne de son service r\u00e9ponde aux \u00e9ventuelles questions du SAA au sujet de l\u2019accompagnement demand\u00e9.<\/li><li>Le partenaire renseigne un num\u00e9ro de t\u00e9l\u00e9phone et une adresse mail auxquels il est facilement joignable (\u00e9vitant le num\u00e9ro g\u00e9n\u00e9ral du type 0800 ou celui d\u2019une centrale).<\/li><li>Lorsque le formulaire est incomplet ou la demande impr\u00e9cise, le SAA renvoie la demande au partenaire demandeur en soulignant les \u00e9l\u00e9ments manquants. La demande n\u2019est trait\u00e9e qu\u2019une fois revenue compl\u00e8te au SAA.<\/li><li>Le partenaire demandeur peut rencontrer le volontaire avant l\u2019accompagnement pour r\u00e9aliser un passage de relai oral ou t\u00e9l\u00e9phonique. Cette rencontre ne s\u2019organise que le jour de l\u2019accompagnement, une demi-heure avant le d\u00e9part.<\/li><\/ul>\n\n\n\n<ol start=\"6\"><li><strong><u>Trajet<\/u><\/strong><\/li><\/ol>\n\n\n\n<ul><li>L\u2019usager prend en charge ses frais de transport, tandis que le transport du volontaire est pris en charge par \u00ab&nbsp;Les Amis d\u2019Accompagner&nbsp;\u00bb.<\/li><li>Si la mobilit\u00e9 de l\u2019usager est r\u00e9duite, le service demandeur organise un transport adapt\u00e9 aux besoins. Le co\u00fbt de ce transport ne peut \u00eatre avanc\u00e9 ni assur\u00e9 par \u00ab&nbsp;Les Amis d\u2019Accompagner&nbsp;\u00bb.<\/li><li>Si l\u2019\u00e9tat de l\u2019usager \u00e0 accompagner en transport en commun n\u00e9cessite l\u2019organisation d\u2019un transport adapt\u00e9, mais que cela n\u2019a pas \u00e9t\u00e9 fait par le partenaire demandeur, le volontaire a la possibilit\u00e9 de faire appel au service d\u2019un taxi, \u00e0 charge du partenaire demandeur&nbsp;: le volontaire l\u2019en avertit par t\u00e9l\u00e9phone. Il peut aussi d\u00e9cider, avec l\u2019accord pr\u00e9alable du SAA, d\u2019interrompre l\u2019accompagnement.<\/li><li>Contacter le SAA (02\/580.20.33) avant d\u2019introduire la demande d\u2019accompagnement en dehors de Bruxelles.<\/li><\/ul>\n\n\n\n<ol start=\"7\"><li><strong><u>Retour<\/u><\/strong><\/li><\/ol>\n\n\n\n<p>Apr\u00e8s l\u2019accompagnement, le partenaire re\u00e7oit un retour de mission par mail \u00e0 l\u2019adresse renseign\u00e9e dans le formulaire. Il prend connaissance de ce retour avant toute nouvelle demande relative \u00e0 son usager.<\/p>\n\n\n\n<ol start=\"8\"><li><strong><u>Consid\u00e9rations sp\u00e9cifiques<\/u><\/strong><\/li><\/ol>\n\n\n\n<ul><li>Tout partenaire introduisant une demande d\u2019accompagnement doit signer les pr\u00e9sentes conditions g\u00e9n\u00e9rales de collaboration qui l\u2019engagent \u00e0 respecter le fonctionnement du SAA.<\/li><li>Apr\u00e8s cinq demandes d\u2019accompagnement, le SAA proposera une rencontre avec l\u2019\u00e9quipe du partenaire demandeur afin de pr\u00e9senter son fonctionnement.<\/li><li>Si les demandes d\u2019un partenaire devaient \u00eatre trop nombreuses, le SAA se r\u00e9servera le droit de restreindre le nombre de demandes afin d\u2019offrir son service \u00e0 l\u2019ensemble de ses partenaires.<\/li><\/ul>\n\n\n\n<p>PS&nbsp;: Pour les cas particuliers qui n\u2019entrent pas dans ces conditions, il est toujours possible de contacter le SAA afin de pr\u00e9senter la situation. Le service prendra alors une d\u00e9cision au cas par cas.<\/p>\n\n\n\n<ol start=\"9\"><li><strong><u>Clause de non-responsabilit\u00e9<\/u><\/strong><\/li><\/ol>\n\n\n\n<ul><li>\u00ab&nbsp;Les Amis d\u2019Accompagner&nbsp;\u00bb d\u00e9cline toute responsabilit\u00e9 pour les cons\u00e9quences dues aux comportements inappropri\u00e9s des usagers ou tout acte de ces derniers pouvant entra\u00eener un pr\u00e9judice quelconque aux tiers, lors de leur accompagnement par un de nos volontaires.<\/li><li>Le volontaire peut interrompre l\u2019accompagnement si l\u2019usager manifeste un comportement agressif ou s\u2019il lui fait part de ne pas\/plus vouloir \u00eatre accompagn\u00e9.<\/li><\/ul>\n\n\n\n<ol start=\"10\"><li><strong><u>Ce que l\u2019asbl Les Amis d\u2019Accompagner&nbsp;attend de ses partenaires<\/u><\/strong><\/li><\/ol>\n\n\n\n<ul><li>Connaitre et respecter ses \u00ab&nbsp;Conditions G\u00e9n\u00e9rales de Collaboration&nbsp;\u00bb.<\/li><li>Comprendre notre clause de sous-traitance en conformit\u00e9 avec le RGPD<a href=\"#_ftn2\">[2]<\/a>.<\/li><li>Int\u00e9grer son fonctionnement, sa mission, ses outils, ses horaires \u2026&nbsp;<\/li><li>Avoir une \u00ab&nbsp;personne de r\u00e9f\u00e9rence&nbsp;\u00bb \u00e0 contacter chez le partenaire.<\/li><li>Obtenir des formulaires de demande d\u2019accompagnement clairs, pr\u00e9cis et complets en mati\u00e8re de d\u00e9marche \u00e0 r\u00e9aliser avec l\u2019usager.<\/li><li>Contribuer activement \u00e0 l\u2019\u00e9valuation annuelle de la collaboration.<\/li><li>Participer \u00e0 la rencontre annuelle des partenaires organis\u00e9e par le SAA.<\/li><li>Offrir une visibilit\u00e9 et une compr\u00e9hension de l\u2019Association en diffusant son existence tant en interne (coll\u00e8gues), qu\u2019en externe (services apparent\u00e9s, r\u00e9seau associatif&nbsp;ou encore en apposant le logo de l\u2019Association sur le site du partenaire).<\/li><\/ul>\n\n\n\n<p><a href=\"#_ftnref1\">[1]<\/a> Si vous n\u2019avez re\u00e7u aucun message en r\u00e9ponse de l\u2019envoi du formulaire, v\u00e9rifiez si la confirmation ne figure pas dans vos spams.<\/p>\n\n\n\n<p><a href=\"#_ftnref2\">[2]<\/a> R\u00e8glement g\u00e9n\u00e9ral sur la protection des donn\u00e9es<\/p>\n<\/div><\/div>\n<\/div><\/div><\/div>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-advgb-column advgb-column advgb-is-half-tablet advgb-is-full-mobile\" id=\"advgb-col-3de27a41-07b5-4a1d-a00f-4ae26c3db136\"><div class=\"advgb-column-inner\" style=\"border-style:none;border-width:1px\">\n<div class=\"wp-block-advgb-columns advgb-columns-wrapper resizable box-solid-blue\" id=\"advgb-cols-e8829e06-c995-456a-8673-e7066b808d2c\"><div class=\"advgb-columns-container\"><div class=\"advgb-columns advgb-columns-row advgb-is-mobile advgb-columns-1 layout-100 mbl-layout-stacked vgutter-10\" style=\"min-height:200px;max-height:200px\">\n<div class=\"wp-block-advgb-column advgb-column advgb-is-full-mobile\" id=\"advgb-col-27cb54b0-59cc-43c0-b136-020b79bb28ef\"><div class=\"advgb-column-inner\" style=\"border-style:none;border-color:#0693e3;border-width:1px\">\n<p><strong><u>RGPD \u2013 Clauses de sous-traitance<\/u><\/strong><a href=\"#_ftn1\"><strong><u>[1]<\/u><\/strong><\/a><\/p>\n\n\n\n<p><strong>(En conformit\u00e9 avec le R\u00e8glement G\u00e9n\u00e9ral sur la Protection des Donn\u00e9es du 25 mai 2018)<\/strong><\/p>\n\n\n\n<p>[\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026], situ\u00e9 \u00e0 [\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026] et repr\u00e9sent\u00e9 par [\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026\u2026]<\/p>\n\n\n\n<p>(ci-apr\u00e8s d\u00e9nomm\u00e9 \u00ab le responsable de traitement&nbsp;\u00bb)<\/p>\n\n\n\n<p>d&rsquo;une part,<\/p>\n\n\n\n<p>Et<\/p>\n\n\n\n<p>\u00ab&nbsp;Les Amis d\u2019Accompagner&nbsp;\u00bb ASBL, situ\u00e9 \u00e0 1081 Koekelberg, rue Emile Sergijsels, 23 et repr\u00e9sent\u00e9e par Mme. Francine An. Wasukundi \u2013 Charg\u00e9e de l\u2019Accompagnement Ambulatoire<\/p>\n\n\n\n<p>(ci-apr\u00e8s d\u00e9nomm\u00e9 \u00ab le sous-traitant&nbsp;\u00bb)<\/p>\n\n\n\n<p>d\u2019autre part,<\/p>\n\n\n\n<ol><li><strong>Objet<\/strong><\/li><\/ol>\n\n\n\n<p>Les pr\u00e9sentes clauses ont pour objet de d\u00e9finir les conditions dans lesquelles le sous-traitant (Les Amis d\u2019Accompagner) s\u2019engage \u00e0 effectuer pour le compte du responsable de traitement (Partenaires) les op\u00e9rations de traitement de donn\u00e9es \u00e0 caract\u00e8re personnel d\u00e9finies ci-apr\u00e8s. Dans le cadre de leurs relations contractuelles, les parties s\u2019engagent \u00e0 respecter la r\u00e9glementation en vigueur applicable au traitement de donn\u00e9es \u00e0 caract\u00e8re personnel (ci-apr\u00e8s, \u00ab le r\u00e8glement europ\u00e9en sur la protection des donn\u00e9es, RGPD \u00bb).<\/p>\n\n\n\n<ol><li><strong>Description du traitement faisant l\u2019objet de la sous-traitance<\/strong><\/li><\/ol>\n\n\n\n<p>Le sous-traitant est autoris\u00e9 \u00e0 traiter pour le compte du responsable de traitement les donn\u00e9es \u00e0 caract\u00e8re personnel n\u00e9cessaires pour fournir le service d\u2019accompagnement ambulatoire (ou \u00ab&nbsp;accompagnement de terrain&nbsp;\u00bb) du public du responsable de traitement par des volontaires du sous-traitant.<\/p>\n\n\n\n<p>La nature des op\u00e9rations r\u00e9alis\u00e9es sur les donn\u00e9es est la collecte, l\u2019encodage des donn\u00e9es dans la base de donn\u00e9e du sous-traitant et l\u2019envoi de celles-ci vers le volontaire du sous-traitant, en vue de r\u00e9aliser l\u2019accompagnement ambulatoire.<\/p>\n\n\n\n<p>La finalit\u00e9 du traitement est de faciliter l\u2019accompagnement de terrain et permettre la r\u00e9alisation du ou des objectifs fix\u00e9s par le responsable de traitement. En fonction des situations soumises, celui-ci, sera amen\u00e9 \u00e0 communiquer des donn\u00e9es \u00e0 caract\u00e8re personnel notamment&nbsp;: donn\u00e9es d&rsquo;identification personnelle&nbsp;; donn\u00e9es de contact&nbsp;; donn\u00e9es communiqu\u00e9es par un organisme public ; donn\u00e9es financi\u00e8res&nbsp;; la profession&nbsp;; des donn\u00e9es de sant\u00e9 (sensible)&nbsp;; situation probl\u00e8me&nbsp;; et dans de rares situations, laisser \u00e0 l\u2019appr\u00e9ciation du partenaire, l\u2019origine ethnique ou raciale (sensible)&nbsp;ainsi que l\u2019orientation sexuelle (sensible).&nbsp;<\/p>\n\n\n\n<p>Les cat\u00e9gories de personnes concern\u00e9es sont le responsable de traitement,&nbsp;et la personne concern\u00e9e par la situation probl\u00e8me.<\/p>\n\n\n\n<ul><li><strong>Dur\u00e9e du contrat<\/strong><\/li><\/ul>\n\n\n\n<p>Le pr\u00e9sent contrat entre en vigueur \u00e0 compter de la date de la signature de l\u2019accord de partenariat pour une dur\u00e9e de 1 an, automatiquement renouvel\u00e9 \u00e0 \u00e9ch\u00e9ance. Le pr\u00e9sent contrat peut \u00eatre unilat\u00e9ralement rompu \u00e0 tout moment, moyennant un pr\u00e9avis d\u2019un mois. Afin d\u2019acter la rupture, un courrier recommand\u00e9 sera envoy\u00e9 \u00e0 l\u2019autre partie, stipulant la fin du contrat.<\/p>\n\n\n\n<ol><li><strong>Obligations de Les Amis d\u2019Accompagner vis-\u00e0-vis du Partenaire<\/strong><\/li><\/ol>\n\n\n\n<p>Le sous-traitant s&rsquo;engage \u00e0 :<\/p>\n\n\n\n<ol><li>Traiter les donn\u00e9es uniquement pour la ou les seule(s) finalit\u00e9(s) qui fait\/font l\u2019objet de la sous-traitance.<\/li><li>Garantir la confidentialit\u00e9 des donn\u00e9es \u00e0 caract\u00e8re personnel trait\u00e9es dans le cadre du pr\u00e9sent contrat.<\/li><li>Veiller \u00e0 ce que les personnes autoris\u00e9es \u00e0 traiter les donn\u00e9es \u00e0 caract\u00e8re personnel en vertu du pr\u00e9sent contrat :<\/li><\/ol>\n\n\n\n<ul><li>S\u2019engagent \u00e0 respecter la confidentialit\u00e9 ou soient soumises \u00e0 une obligation l\u00e9gale appropri\u00e9e de confidentialit\u00e9&nbsp;;<\/li><li>Re\u00e7oivent la formation n\u00e9cessaire en mati\u00e8re de protection des donn\u00e9es \u00e0 caract\u00e8re personnel.<\/li><\/ul>\n\n\n\n<ol start=\"4\"><li>Respecter le droit d\u2019information des personnes concern\u00e9es.<\/li><\/ol>\n\n\n\n<p>Il appartient au responsable de traitement de fournir l\u2019information aux personnes concern\u00e9es par les op\u00e9rations de traitement au moment de la collecte des donn\u00e9es.&nbsp;<\/p>\n\n\n\n<ol start=\"5\"><li>Mettre en \u0153uvre l\u2019exercice des droits des personnes.<\/li><\/ol>\n\n\n\n<p>Lorsque les personnes concern\u00e9es exercent aupr\u00e8s du sous-traitant des demandes d\u2019exercice de leurs droits, le sous-traitant doit adresser ces demandes d\u00e8s r\u00e9ception par courrier \u00e9lectronique.<\/p>\n\n\n\n<ol start=\"6\"><li>Notifier les violations de donn\u00e9es \u00e0 caract\u00e8re personnel<\/li><\/ol>\n\n\n\n<p>Le sous-traitant notifie au responsable de traitement toute violation de donn\u00e9es \u00e0 caract\u00e8re personnel dans un d\u00e9lai maximum de 24 heures apr\u00e8s en avoir pris connaissance courrier \u00e9lectronique au responsable de traitement. Cette notification est accompagn\u00e9e de toute documentation utile afin de permettre au responsable de traitement, si n\u00e9cessaire, de notifier cette violation \u00e0 l\u2019autorit\u00e9 de contr\u00f4le comp\u00e9tente.<\/p>\n\n\n\n<p>La notification contient au moins :<\/p>\n\n\n\n<ul><li>la description de la nature de la violation de donn\u00e9es \u00e0 caract\u00e8re personnel y compris, si possible, les cat\u00e9gories et le nombre approximatif de personnes concern\u00e9es par la violation et les cat\u00e9gories et le nombre approximatif d&rsquo;enregistrements de donn\u00e9es \u00e0 caract\u00e8re personnel concern\u00e9s ;<\/li><li>le nom et les coordonn\u00e9es du d\u00e9l\u00e9gu\u00e9 \u00e0 la protection des donn\u00e9es ou d&rsquo;un autre point de contact aupr\u00e8s duquel des informations suppl\u00e9mentaires peuvent \u00eatre obtenues ;<\/li><li>la description des cons\u00e9quences probables de la violation de donn\u00e9es \u00e0 caract\u00e8re personnel ;<\/li><li>la description des mesures prises ou que le responsable du traitement propose de prendre pour rem\u00e9dier \u00e0 la violation de donn\u00e9es \u00e0 caract\u00e8re personnel, y compris, le cas \u00e9ch\u00e9ant, les mesures pour en att\u00e9nuer les \u00e9ventuelles cons\u00e9quences n\u00e9gatives.<\/li><\/ul>\n\n\n\n<p>Si, et dans la mesure o\u00f9 il n\u2019est pas possible de fournir toutes ces informations en m\u00eame temps, les informations peuvent \u00eatre communiqu\u00e9es de mani\u00e8re \u00e9chelonn\u00e9e sans retard indu.<\/p>\n\n\n\n<ol start=\"7\"><li>Mettre en \u0153uvre les mesures de s\u00e9curit\u00e9 suivantes&nbsp;:<\/li><\/ol>\n\n\n\n<ul><li>Les moyens permettant de garantir la confidentialit\u00e9, l&rsquo;int\u00e9grit\u00e9, la disponibilit\u00e9 et la r\u00e9silience constantes des syst\u00e8mes et des services de traitement&nbsp;;<\/li><li>Les moyens permettant de r\u00e9tablir la disponibilit\u00e9 des donn\u00e9es \u00e0 caract\u00e8re personnel et l&rsquo;acc\u00e8s \u00e0 celles-ci dans des d\u00e9lais appropri\u00e9s en cas d&rsquo;incident physique ou technique&nbsp;;<\/li><li>Une proc\u00e9dure visant \u00e0 tester, \u00e0 analyser et \u00e0 \u00e9valuer r\u00e9guli\u00e8rement l&rsquo;efficacit\u00e9 des mesures techniques et organisationnelles pour assurer la s\u00e9curit\u00e9 du traitement.<\/li><\/ul>\n\n\n\n<ol start=\"8\"><li>Archiver les donn\u00e9es de la prestation de services au terme d\u2019une p\u00e9riode de deux ann\u00e9es civiles, ceci afin de lui permettre la n\u00e9cessaire gestion interne. Cette p\u00e9riode de deux ann\u00e9es sera automatiquement r\u00e9initialis\u00e9e apr\u00e8s toute nouvelle demande de prestation de services. Au terme de 7 ann\u00e9es civiles, les donn\u00e9es seront alors anonymis\u00e9es.<\/li><li>Registre des cat\u00e9gories d\u2019activit\u00e9s de traitement<\/li><\/ol>\n\n\n\n<p>Le sous-traitant d\u00e9clare tenir par \u00e9crit un registre de toutes les cat\u00e9gories d\u2019activit\u00e9s de traitement effectu\u00e9es pour le compte du responsable de traitement comprenant :<\/p>\n\n\n\n<ul><li>le nom et les coordonn\u00e9es du responsable de traitement pour le compte duquel il agit, des \u00e9ventuels sous-traitants et, le cas \u00e9ch\u00e9ant, du d\u00e9l\u00e9gu\u00e9 \u00e0 la protection des donn\u00e9es&nbsp;;<\/li><li>les cat\u00e9gories de traitements effectu\u00e9s pour le compte du responsable du traitement&nbsp;;<\/li><li>Une description g\u00e9n\u00e9rale des mesures de s\u00e9curit\u00e9 techniques et organisationnelles (voir point 7).<\/li><\/ul>\n\n\n\n<ol start=\"10\"><li>Documentation<\/li><\/ol>\n\n\n\n<p>Le sous-traitant met \u00e0 la disposition du responsable de traitement la documentation n\u00e9cessaire pour d\u00e9montrer le respect de toutes ses obligations et pour permettre la r\u00e9alisation d&rsquo;audits, y compris des inspections, par le responsable du traitement ou un autre auditeur qu&rsquo;il a mandat\u00e9, et contribuer \u00e0 ces audits.<\/p>\n\n\n\n<ol><li><strong>Obligations du Partenaire vis-\u00e0-vis de Les Amis d\u2019Accompagner<\/strong><\/li><\/ol>\n\n\n\n<p>Le responsable de traitement s\u2019engage \u00e0 :<\/p>\n\n\n\n<ol><li>Fournir au sous-traitant les donn\u00e9es vis\u00e9es au point II \u00ab&nbsp;<em>Description du traitement faisant l\u2019objet de la sous-traitance&nbsp;\u00bb<\/em> des pr\u00e9sentes clauses&nbsp;;<\/li><li>Documenter par \u00e9crit toute instruction concernant le traitement des donn\u00e9es par le sous-traitant&nbsp;;<\/li><li>Veiller, au pr\u00e9alable et pendant toute la dur\u00e9e du traitement, au respect des obligations pr\u00e9vues par le r\u00e8glement europ\u00e9en sur la protection des donn\u00e9es de la part du sous-traitant&nbsp;;<\/li><li>Superviser le traitement, y compris r\u00e9aliser les audits et les inspections aupr\u00e8s du sous-traitant.<\/li><\/ol>\n\n\n\n<p><a href=\"#_ftnref1\">[1]<\/a> <em>Source&nbsp;: Commission nationale de l\u2019informatique et des libert\u00e9 \u2013 Cnil&nbsp;: <\/em><a href=\"https:\/\/www.cnil.fr\/sites\/default\/files\/atoms\/files\/rgpd-guide_sous-traitant-cnil.pdf\"><em>https:\/\/www.cnil.fr\/sites\/default\/files\/atoms\/files\/rgpd-guide_sous-traitant-cnil.pdf<\/em><\/a><\/p>\n<\/div><\/div>\n<\/div><\/div><\/div>\n<\/div><\/div>\n<\/div><\/div><\/div>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<div class=\"wp-block-columns\">\n<div class=\"wp-block-column\" style=\"flex-basis:100%\">\n<div class=\"wp-block-columns\">\n<div class=\"wp-block-column\">\n<div class=\"wp-block-columns\">\n<div class=\"wp-block-column\"><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<p><\/p>\n\n\n\n<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-6401\"><form id=\"wpforms-form-6401\" class=\"wpforms-validate wpforms-form\" data-formid=\"6401\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/fr\/wp-json\/wp\/v2\/pages\/8860\"><div class=\"wpforms-field-container\"><div id=\"wpforms-6401-field_26-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"26\"><h3 id=\"wpforms-6401-field_26\" name=\"wpforms[fields][26]\">Vos coordonn\u00e9es [Institution demandant l&#039;accompagnement]<\/h3><\/div><div id=\"wpforms-6401-field_6-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_6\">Pr\u00e9nom et nom du travailleur <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-6401-field_6\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][6][first]\" placeholder=\"Pr\u00e9nom du travailleur\" required><label for=\"wpforms-6401-field_6\" class=\"wpforms-field-sublabel after \">Pr\u00e9nom<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-6401-field_6-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][6][last]\" placeholder=\"Nom du travailleur\" required><label for=\"wpforms-6401-field_6-last\" class=\"wpforms-field-sublabel after \">Nom<\/label><\/div><\/div><\/div><div id=\"wpforms-6401-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_11\">Nom de l\u2019institution sollicitant l\u2019accompagnement <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" required><\/div><div id=\"wpforms-6401-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_13\">Nom de votre service<\/label><input type=\"text\" id=\"wpforms-6401-field_13\" class=\"wpforms-field-medium\" name=\"wpforms[fields][13]\" ><\/div><div id=\"wpforms-6401-field_7-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_7\">Votre adresse mail <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"email\" id=\"wpforms-6401-field_7\" class=\"wpforms-field-required wpforms-field-email-primary\" name=\"wpforms[fields][7][primary]\" required><label for=\"wpforms-6401-field_7\" class=\"wpforms-field-sublabel after \">E-mail<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"email\" id=\"wpforms-6401-field_7-secondary\" class=\"wpforms-field-email-secondary wpforms-field-required\" data-rule-confirm=\"#wpforms-6401-field_7\" name=\"wpforms[fields][7][secondary]\" required><label for=\"wpforms-6401-field_7-secondary\" class=\"wpforms-field-sublabel after \">Confirmez l\u2019e-mail<\/label><\/div><\/div><\/div><div id=\"wpforms-6401-field_98-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"98\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_98\">Adresse mail d&#039;un.e coll\u00e8gue si je suis absent.e <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"email\" id=\"wpforms-6401-field_98\" class=\"wpforms-field-required wpforms-field-email-primary\" name=\"wpforms[fields][98][primary]\" required><label for=\"wpforms-6401-field_98\" class=\"wpforms-field-sublabel after \">E-mail<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"email\" id=\"wpforms-6401-field_98-secondary\" class=\"wpforms-field-email-secondary wpforms-field-required\" data-rule-confirm=\"#wpforms-6401-field_98\" name=\"wpforms[fields][98][secondary]\" required><label for=\"wpforms-6401-field_98-secondary\" class=\"wpforms-field-sublabel after \">Confirmez l\u2019e-mail<\/label><\/div><\/div><\/div><div id=\"wpforms-6401-field_78-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"78\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_78\">Num\u00e9ro de t\u00e9l\u00e9phone auquel vous joindre  <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_78\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][78]\" required><div class=\"wpforms-field-description\">Num\u00e9ro de t\u00e9l\u00e9phone belge fixe ou gsm.<\/div><\/div><div id=\"wpforms-6401-field_20-container\" class=\"wpforms-field wpforms-field-divider h5\" data-field-id=\"20\"><h3 id=\"wpforms-6401-field_20\" name=\"wpforms[fields][20]\">Coordonn\u00e9es du b\u00e9n\u00e9ficiaire de l&#039;accompagnement<\/h3><\/div><div id=\"wpforms-6401-field_16-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_16\">Pr\u00e9nom et nom de l&#039;usager <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-6401-field_16\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][16][first]\" required><label for=\"wpforms-6401-field_16\" class=\"wpforms-field-sublabel after \">Pr\u00e9nom<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-6401-field_16-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][16][last]\" required><label for=\"wpforms-6401-field_16-last\" class=\"wpforms-field-sublabel after \">Nom<\/label><\/div><\/div><\/div><div id=\"wpforms-6401-field_79-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"79\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_79\">Son num\u00e9ro de t\u00e9l\u00e9phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_79\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][79]\" required><div class=\"wpforms-field-description\">Num\u00e9ro de t\u00e9l\u00e9phone belge Fixe ou Gsm.<\/div><\/div><div id=\"wpforms-6401-field_19-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_19\">Est-ce la 1\u00e8re demande pour cette personne ?  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_19_1\" name=\"wpforms[fields][19]\" value=\"Oui\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_19_1\">Oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_19_2\" name=\"wpforms[fields][19]\" value=\"Non\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_19_2\">Non<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_23-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"23\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_23\">Veuillez confirmer que le b\u00e9n\u00e9ficiaire est inform\u00e9 de la raison pour laquelle un accompagnement est demand\u00e9 ; qu&#039;il consent \u00e0 la mani\u00e8re dont l&#039;information et les donn\u00e9es personnelles circulent entre votre service et Les Amis d&#039;Accompagner. <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_23\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-6401-field_23_1\" name=\"wpforms[fields][23][]\" value=\"Oui\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_23_1\">Oui<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_24-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"24\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_24\">Sexe <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_24\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_24_1\" name=\"wpforms[fields][24]\" value=\"H\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_24_1\">H<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_24_2\" name=\"wpforms[fields][24]\" value=\"F\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_24_2\">F<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_25-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"25\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_25\">Sa date de naissance <span class=\"wpforms-required-label\">*<\/span><\/label><select name=\"wpforms[fields][25][date][d]\" id=\"wpforms-field_25-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>JJ<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][25][date][m]\" id=\"wpforms-field_25-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][25][date][y]\" id=\"wpforms-field_25-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>AAAA<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><div id=\"wpforms-6401-field_28-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"28\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_28\">Son adresse <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_28\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][28]\" placeholder=\"Si n\u00e9cessaire, merci de bien d\u00e9tailler cette adresse : sonnette, n\u00b0, \u00e9tage, etc\" required><\/div><div id=\"wpforms-6401-field_29-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"29\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_29\">Sa nationalit\u00e9 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_29\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][29]\" required><\/div><div id=\"wpforms-6401-field_30-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"30\" style=\"display:none;\"><div id=\"wpforms-6401-field_30\"><div><hr style=\"border-top: 2px dashed red;\" ;=\"\"> --- Si votre b\u00e9n\u00e9ficiaire n'est pas belge ou naturalis\u00e9 belge ---<\/div><\/div><\/div><div id=\"wpforms-6401-field_31-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"31\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_31\">Sa date d&#039;arriv\u00e9e en Belgique<\/label><select name=\"wpforms[fields][31][date][d]\" id=\"wpforms-field_31-day\" class=\"wpforms-field-date-time-date-day\" ><option class=\"placeholder\" selected disabled>JJ<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][31][date][m]\" id=\"wpforms-field_31-month\" class=\"wpforms-field-date-time-date-month\" ><option class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][31][date][y]\" id=\"wpforms-field_31-year\" class=\"wpforms-field-date-time-date-year\" ><option class=\"placeholder\" selected disabled>AAAA<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><div id=\"wpforms-6401-field_32-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"32\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_32\">Son titre de s\u00e9jour <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_32\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][32]\" required=\"required\"><option value=\"-- Choisir --\" >-- Choisir --<\/option><option value=\"Autorisation provisoire de s\u00e9jour\" >Autorisation provisoire de s\u00e9jour<\/option><option value=\"Carte de r\u00e9fugi\u00e9(e)\" >Carte de r\u00e9fugi\u00e9(e)<\/option><option value=\"Demande d&#039;asile\" >Demande d&#039;asile<\/option><option value=\"Demande de r\u00e9gularisation\" >Demande de r\u00e9gularisation<\/option><option value=\"Inscrit au Registre des \u00e9trangers\" >Inscrit au Registre des \u00e9trangers<\/option><option value=\"Sans statut\" >Sans statut<\/option><\/select><\/div><div id=\"wpforms-6401-field_36-container\" class=\"wpforms-field wpforms-field-html wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"36\" style=\"display:none;\"><div id=\"wpforms-6401-field_36\"><hr style=\"border-top: 2px dashed red;\"><\/div><\/div><div id=\"wpforms-6401-field_34-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"34\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_34\">Origine de ses ressources  <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_34\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][34]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Il s&#039;agit de la ressource principale de votre usager<\/option><option value=\"Travail\" >Travail<\/option><option value=\"Allocation de ch\u00f4mage\" >Allocation de ch\u00f4mage<\/option><option value=\"Revenu d&#039;int\u00e9gration (CPAS)\" >Revenu d&#039;int\u00e9gration (CPAS)<\/option><option value=\"Pension de retraite\" >Pension de retraite<\/option><option value=\"Allocations familiales\" >Allocations familiales<\/option><option value=\"Pension alimentaire\" >Pension alimentaire<\/option><option value=\"Bourse d&#039;\u00e9tude\" >Bourse d&#039;\u00e9tude<\/option><option value=\"Sans revenus\" >Sans revenus<\/option><option value=\"Autre\" >Autre<\/option><\/select><\/div><div id=\"wpforms-6401-field_77-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"77\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_77\">Veuillez pr\u00e9cisez <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_77\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][77]\" required><\/div><div id=\"wpforms-6401-field_104-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"104\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_104\">Sa situation familiale <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_104\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][104]\" required=\"required\"><option value=\"-- Choisir --\" >-- Choisir --<\/option><option value=\"Isol\u00e9(e)\" >Isol\u00e9(e)<\/option><option value=\"Couple sans enfant\" >Couple sans enfant<\/option><option value=\"Couple avec enfant(s)\" >Couple avec enfant(s)<\/option><option value=\"Cohabitant(e) de fait\" >Cohabitant(e) de fait<\/option><option value=\"Famille monoparentale\" >Famille monoparentale<\/option><\/select><\/div><div id=\"wpforms-6401-field_37-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"37\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_37\">Son \u00e9tat civil <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_37\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][37]\" required=\"required\"><option value=\"-- Choisir --\" >-- Choisir --<\/option><option value=\"C\u00e9libataire\" >C\u00e9libataire<\/option><option value=\"Mari\u00e9(e)\" >Mari\u00e9(e)<\/option><option value=\"S\u00e9par\u00e9(e)\" >S\u00e9par\u00e9(e)<\/option><option value=\"Divorc\u00e9(e)\" >Divorc\u00e9(e)<\/option><option value=\"Veuf(ve)\" >Veuf(ve)<\/option><\/select><\/div><div id=\"wpforms-6401-field_39-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"39\"><h3 id=\"wpforms-6401-field_39\" name=\"wpforms[fields][39]\">Accompagnement \u00e0 effectuer<\/h3><\/div><div id=\"wpforms-6401-field_40-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"40\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_40\">Date de l&#039;accompagnement <span class=\"wpforms-required-label\">*<\/span><\/label><select name=\"wpforms[fields][40][date][d]\" id=\"wpforms-field_40-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>JJ<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][40][date][m]\" id=\"wpforms-field_40-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><span class=\"wpforms-field-date-time-date-sep\">\/<\/span><select name=\"wpforms[fields][40][date][y]\" id=\"wpforms-field_40-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option class=\"placeholder\" selected disabled>AAAA<\/option><option value=\"2026\" >2026<\/option><option value=\"2027\" >2027<\/option><\/select><\/div><div id=\"wpforms-6401-field_73-container\" class=\"wpforms-field wpforms-field-date-time wpf_6pct\" data-field-id=\"73\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_73\">Heure du rendez-vous entre le b\u00e9n\u00e9ficiaire et l\u2019accompagnant <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_73-time\" class=\"wpforms-field-date-time-time\" data-rule-time24h=\"true\" data-time-format=\"H:i\" data-step=\"30\" name=\"wpforms[fields][73][time]\" placeholder=\"HH:MM\" required><\/div><div id=\"wpforms-6401-field_112-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"112\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_112\">Lieu du rendez-vous b\u00e9n\u00e9ficiaire\/accompagnant <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_112\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][112]\" required><\/div><div id=\"wpforms-6401-field_46-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_46\">Adresse du rendez-vous b\u00e9n\u00e9ficiaire\/accompagnant <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_46\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][46]\" placeholder=\"Merci de bien d\u00e9tailler l&#039;adresse : sonnette, n\u00b0, \u00e9tage, etc.\" required><\/div><div id=\"wpforms-6401-field_47-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"47\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_47\">Nom du lieu o\u00f9 se rendre <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_47\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][47]\" placeholder=\"L&#039;institution o\u00f9 votre usager a rendez-vous\" required><\/div><div id=\"wpforms-6401-field_66-container\" class=\"wpforms-field wpforms-field-text wpforms-two-fourths wpforms-first\" data-field-id=\"66\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_66\">Adresse du lieu o\u00f9 se rendre <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_66\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][66]\" placeholder=\"Nom de la rue \" required><\/div><div id=\"wpforms-6401-field_70-container\" class=\"wpforms-field wpforms-field-number wpforms-one-third wpforms-first\" data-field-id=\"70\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_70\">Code postal et localit\u00e9 <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" pattern=\"[0-9]*\" id=\"wpforms-6401-field_70\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][70]\" required><\/div><div id=\"wpforms-6401-field_74-container\" class=\"wpforms-field wpforms-field-date-time wpf_6pct\" data-field-id=\"74\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_74\">Heure du rendez-vous ou de la permanence \u00e0 laquelle le b\u00e9n\u00e9ficiaire doit se rendre <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_74-time\" class=\"wpforms-field-date-time-time\" data-rule-time24h=\"true\" data-time-format=\"H:i\" data-step=\"30\" name=\"wpforms[fields][74][time]\" placeholder=\"HH:MM\" required><\/div><div id=\"wpforms-6401-field_51-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_51\">Nom de la personne que le b\u00e9n\u00e9ficiaire doit rencontrer <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_51\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][51]\" placeholder=\"L&#039;interlocuteur de l&#039;usager lors de son rendez-vous\" required><div class=\"wpforms-field-description\">Sinon marquez : Inconnu<\/div><\/div><div id=\"wpforms-6401-field_80-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"80\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_80\">Num\u00e9ro de t\u00e9l\u00e9phone de la personne que le b\u00e9n\u00e9ficiaire doit rencontrer <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-6401-field_80\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][80]\" required><div class=\"wpforms-field-description\">Num\u00e9ro de t\u00e9l\u00e9phone belge Fixe ou Gsm.<\/div><\/div><div id=\"wpforms-6401-field_108-container\" class=\"wpforms-field wpforms-field-select\" data-field-id=\"108\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_108\">Raison n\u00e9cessistant l&#039;accompagnement <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-6401-field_108\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][108]\" required=\"required\"><option value=\"Veuillez choisir ce qui correspond\" >Veuillez choisir ce qui correspond<\/option><option value=\"Soutien moral\" >Soutien moral<\/option><option value=\"Soutien linguistique\" >Soutien linguistique<\/option><option value=\"Aide \u00e0 la compr\u00e9hension\" >Aide \u00e0 la compr\u00e9hension<\/option><option value=\"Orientation dans l&#039;espace\" >Orientation dans l&#039;espace<\/option><option value=\"Soutien physique durant le d\u00e9placement\" >Soutien physique durant le d\u00e9placement<\/option><option value=\"Aide \u00e0 la prise de notes\" >Aide \u00e0 la prise de notes<\/option><option value=\"Classement\/organisation\" >Classement\/organisation<\/option><option value=\"Autre\" >Autre<\/option><\/select><div class=\"wpforms-field-description\">=>Attention, nous ne sommes pas un service sp\u00e9cialis\u00e9 dans la traduction. =>Attention, nos volontaires ne sont pas habilit\u00e9s \u00e0 transporter des bagages, ni \u00e0 pousser une chaise roulante, ni \u00e0 faire des accompagnements avec leur v\u00e9hicule.<\/div><\/div><div id=\"wpforms-6401-field_110-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"110\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_110\">Veuillez expliciter votre choix<\/label><input type=\"text\" id=\"wpforms-6401-field_110\" class=\"wpforms-field-medium\" name=\"wpforms[fields][110]\" placeholder=\"Explicitez votre choix\" ><\/div><div id=\"wpforms-6401-field_54-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_54\">Besoin de traduction (interpr\u00e9tariat) <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_54\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_54_1\" name=\"wpforms[fields][54]\" value=\"oui\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_54_1\">oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_54_2\" name=\"wpforms[fields][54]\" value=\"non\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_54_2\">non<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_54_3\" name=\"wpforms[fields][54]\" value=\"oui mais pas indispensable. Le b\u00e9n\u00e9ficiare ma\u00eetrise un peu la langue.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_54_3\">oui mais pas indispensable. Le b\u00e9n\u00e9ficiare ma\u00eetrise un peu la langue.<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_55-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"55\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_55\">Langue parl\u00e9e par le b\u00e9n\u00e9ficiaire<\/label><input type=\"text\" id=\"wpforms-6401-field_55\" class=\"wpforms-field-small\" name=\"wpforms[fields][55]\" placeholder=\"A remplir si la traduction est souhait\u00e9e\" ><\/div><div id=\"wpforms-6401-field_57-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"57\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_57\">D\u00e9tails de la d\u00e9marche \u00e0 r\u00e9aliser <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-6401-field_57\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][57]\" placeholder=\"D\u00e9tailler la d\u00e9marche que le b\u00e9n\u00e9ficiaire voudrait r\u00e9aliser avec l\u2019aide du b\u00e9n\u00e9vole. Ex.: Rencontrer son m\u00e9decin, obtenir tel ou tel document, apprendre l&#039;itin\u00e9raire jusqu&#039;\u00e0 son nouveau centre de jour,... Description de la situation, du but \u00e0 atteindre, des documents \u00e0 obtenir,...\" required><\/textarea><\/div><div id=\"wpforms-6401-field_58-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"58\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_58\">Informations compl\u00e9mentaires<\/label><textarea id=\"wpforms-6401-field_58\" class=\"wpforms-field-medium\" name=\"wpforms[fields][58]\" placeholder=\"Le cas \u00e9ch\u00e9ant, indiquer les sp\u00e9cificit\u00e9s du b\u00e9n\u00e9ficiaire si celles-ci risquent d\u2019influencer le d\u00e9roulement de l\u2019accompagnement. Ex.: chaise roulante, poussette, difficult\u00e9s \u00e0 la marche, assu\u00e9tude, \u00e9pilepsie, phobie\u2026\" ><\/textarea><\/div><div id=\"wpforms-6401-field_61-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"61\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_61\">Je confirme de munir l&#039;usager des documents recquis pour la r\u00e9alisation de la d\u00e9marche en cours <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_61\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_61_1\" name=\"wpforms[fields][61]\" value=\"oui\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_61_1\">oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_61_2\" name=\"wpforms[fields][61]\" value=\"non applicable\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_61_2\">non applicable<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_96-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"96\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_96\">Retour n\u00e9cessaire avec l&#039;accompagnateur vers le lieu de d\u00e9part de l&#039;accompagnement <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_96\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_96_1\" name=\"wpforms[fields][96]\" value=\"oui\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_96_1\">oui<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-6401-field_96_2\" name=\"wpforms[fields][96]\" value=\"non\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_96_2\">non<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_103-container\" class=\"wpforms-field wpforms-field-gdpr-checkbox\" data-field-id=\"103\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_103\">Accord RGPD et Conditions g\u00e9n\u00e9rales de collaboration <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-6401-field_103\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"checkbox\" id=\"wpforms-6401-field_103_1\" name=\"wpforms[fields][103][]\" value=\"J&#039;ai lu et j&#039;accepte les conditions g\u00e9n\u00e9rales de collaboration. Je consens \u00e0 ce que Les Amis d&#039;Accompagner stocke mes informations afin de r\u00e9pondre \u00e0 ma requ\u00eate.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_103_1\">J'ai lu et j'accepte les conditions g\u00e9n\u00e9rales de collaboration. Je consens \u00e0 ce que Les Amis d'Accompagner stocke mes informations afin de r\u00e9pondre \u00e0 ma requ\u00eate.<\/label><\/li><\/ul><\/div><div id=\"wpforms-6401-field_90-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"90\"><label class=\"wpforms-field-label\" for=\"wpforms-6401-field_90\">En soumettant ce formulaire, j&#039;accepte que l&#039;ASBL Les Amis d&#039;Accompagner<\/label><ul id=\"wpforms-6401-field_90\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-6401-field_90_1\" name=\"wpforms[fields][90][]\" value=\"me contacte pour me transmettre des informations la concernant\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_90_1\">me contacte pour me transmettre des informations la concernant<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-6401-field_90_2\" name=\"wpforms[fields][90][]\" value=\"m\u2019envoie la newsletter\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-6401-field_90_2\">m\u2019envoie la newsletter<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-6401-field-hp\" class=\"wpforms-field-label\">Name<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-6401-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"6401\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"8\"><button type=\"submit\" name=\"wpforms[submit]\" class=\"wpforms-submit \" id=\"wpforms-submit-6401\" value=\"wpforms-submit\" aria-live=\"assertive\" data-alt-text=\"Envoi en cours...\" data-submit-text=\"Envoyer\">Envoyer<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n<style class=\"advgb-styles-renderer\">\n.wp-block-columns {\n    margin-bottom: 0; \/\/ pour \u00e9viter que le cadre avec les 2 download soit trop grand\n}\n#advgb-cols-68554326-c1d5-439b-9c2a-f3b0a08f6b55{margin-top:5px;margin-right:5px;margin-bottom:5px;margin-left:5px;}@media screen and (max-width: 1023px) {#advgb-cols-68554326-c1d5-439b-9c2a-f3b0a08f6b55{}}@media screen and (max-width: 767px) {#advgb-cols-68554326-c1d5-439b-9c2a-f3b0a08f6b55{}}#advgb-col-b7e940c2-61b4-4c64-9b00-d90b8543593c>.advgb-column-inner{margin-top:5px;margin-right:5px;margin-bottom:5px;margin-left:5px;}@media screen and (max-width: 1023px) {#advgb-col-b7e940c2-61b4-4c64-9b00-d90b8543593c>.advgb-column-inner{}}@media screen and (max-width: 767px) {#advgb-col-b7e940c2-61b4-4c64-9b00-d90b8543593c>.advgb-column-inner{}}#advgb-cols-2f226021-3a32-45b8-bb58-da93a37bb737{margin-top:5px;margin-right:5px;margin-bottom:5px;margin-left:5px;padding-top:5px;padding-right:5px;padding-bottom:5px;padding-left:5px;}@media screen and (max-width: 1023px) {#advgb-cols-2f226021-3a32-45b8-bb58-da93a37bb737{}}@media screen and (max-width: 767px) {#advgb-cols-2f226021-3a32-45b8-bb58-da93a37bb737{}}#advgb-col-1c5e4952-6231-42b1-bc14-35cfdd0c26c9>.advgb-column-inner{}@media screen and (max-width: 1023px) {#advgb-col-1c5e4952-6231-42b1-bc14-35cfdd0c26c9>.advgb-column-inner{}}@media screen and (max-width: 767px) {#advgb-col-1c5e4952-6231-42b1-bc14-35cfdd0c26c9>.advgb-column-inner{}}#advgb-col-3de27a41-07b5-4a1d-a00f-4ae26c3db136>.advgb-column-inner{}@media screen and (max-width: 1023px) {#advgb-col-3de27a41-07b5-4a1d-a00f-4ae26c3db136>.advgb-column-inner{}}@media screen and (max-width: 767px) {#advgb-col-3de27a41-07b5-4a1d-a00f-4ae26c3db136>.advgb-column-inner{}}#advgb-cols-e8829e06-c995-456a-8673-e7066b808d2c{margin-top:5px;margin-right:5px;margin-bottom:5px;margin-left:5px;padding-top:5px;padding-right:5px;padding-bottom:5px;padding-left:5px;}@media screen and (max-width: 1023px) {#advgb-cols-e8829e06-c995-456a-8673-e7066b808d2c{}}@media screen and (max-width: 767px) {#advgb-cols-e8829e06-c995-456a-8673-e7066b808d2c{}}#advgb-col-27cb54b0-59cc-43c0-b136-020b79bb28ef>.advgb-column-inner{}@media screen and (max-width: 1023px) {#advgb-col-27cb54b0-59cc-43c0-b136-020b79bb28ef>.advgb-column-inner{}}@media screen and (max-width: 767px) {#advgb-col-27cb54b0-59cc-43c0-b136-020b79bb28ef>.advgb-column-inner{}}<\/style>","protected":false},"excerpt":{"rendered":"<p>U kunt dit formulier ininvullen. Informations utiles avant de compl\u00e9ter le formulaire : Les champs obligatoires marqu\u00e9s d&rsquo;un * contiennent des donn\u00e9es indispensables \u00e0 l&rsquo;ouverture du dossier et au bon d\u00e9roulement de l&rsquo;accompagnement Introduire la demande une semaine avant la date de l&rsquo;accompagnement. De pr\u00e9f\u00e9rence, pr\u00e9voyez des accompagnements entre de 8h30 et 17h00 Attention : [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"advgb_blocks_editor_width":"","advgb_blocks_columns_visual_guide":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v16.3 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Formulaire de demande d&#039;accompagnement ambulatoire - Les Amis d\u2019Accompagner<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/accompagner.be\/fr\/demander-un-accompagnement\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Formulaire de demande d&#039;accompagnement ambulatoire - Les Amis d\u2019Accompagner\" \/>\n<meta property=\"og:description\" content=\"U kunt dit formulier ininvullen. Informations utiles avant de compl\u00e9ter le formulaire : Les champs obligatoires marqu\u00e9s d&rsquo;un * contiennent des donn\u00e9es indispensables \u00e0 l&rsquo;ouverture du dossier et au bon d\u00e9roulement de l&rsquo;accompagnement Introduire la demande une semaine avant la date de l&rsquo;accompagnement. De pr\u00e9f\u00e9rence, pr\u00e9voyez des accompagnements entre de 8h30 et 17h00 Attention : [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/accompagner.be\/fr\/demander-un-accompagnement\/\" \/>\n<meta property=\"og:site_name\" content=\"Les Amis d\u2019Accompagner\" \/>\n<meta property=\"article:modified_time\" content=\"2025-04-02T14:52:21+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/accompagner.be\/wp-content\/uploads\/download-logo.png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture est.\">\n\t<meta name=\"twitter:data1\" content=\"12 minutes\">\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebSite\",\"@id\":\"https:\/\/accompagner.be\/fr\/#website\",\"url\":\"https:\/\/accompagner.be\/fr\/\",\"name\":\"Les Amis d\\u2019Accompagner\",\"description\":\"Ensemble, pas \\u00e0 pas!\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":\"https:\/\/accompagner.be\/fr\/?s={search_term_string}\",\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"fr-FR\"},{\"@type\":\"ImageObject\",\"@id\":\"https:\/\/accompagner.be\/fr\/demander-un-accompagnement\/#primaryimage\",\"inLanguage\":\"fr-FR\",\"url\":\"https:\/\/accompagner.be\/wp-content\/uploads\/download-logo.png\",\"contentUrl\":\"https:\/\/accompagner.be\/wp-content\/uploads\/download-logo.png\",\"width\":234,\"height\":74},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/accompagner.be\/fr\/demander-un-accompagnement\/#webpage\",\"url\":\"https:\/\/accompagner.be\/fr\/demander-un-accompagnement\/\",\"name\":\"Formulaire de demande d'accompagnement ambulatoire - Les Amis d\\u2019Accompagner\",\"isPartOf\":{\"@id\":\"https:\/\/accompagner.be\/fr\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/accompagner.be\/fr\/demander-un-accompagnement\/#primaryimage\"},\"datePublished\":\"2020-06-23T21:34:52+00:00\",\"dateModified\":\"2025-04-02T14:52:21+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/accompagner.be\/fr\/demander-un-accompagnement\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/accompagner.be\/fr\/demander-un-accompagnement\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/accompagner.be\/fr\/demander-un-accompagnement\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"item\":{\"@type\":\"WebPage\",\"@id\":\"https:\/\/accompagner.be\/fr\/\",\"url\":\"https:\/\/accompagner.be\/fr\/\",\"name\":\"Accueil\"}},{\"@type\":\"ListItem\",\"position\":2,\"item\":{\"@id\":\"https:\/\/accompagner.be\/fr\/demander-un-accompagnement\/#webpage\"}}]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","coauthors":[],"author_meta":{"author_link":"https:\/\/accompagner.be\/fr\/author\/phd2019\/","display_name":"PhD2019"},"relative_dates":{"created":"Posted 6 ans ago","modified":"Updated 1 an ago"},"featured_img_caption":"","_links":{"self":[{"href":"https:\/\/accompagner.be\/fr\/wp-json\/wp\/v2\/pages\/8860"}],"collection":[{"href":"https:\/\/accompagner.be\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/accompagner.be\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/accompagner.be\/fr\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/accompagner.be\/fr\/wp-json\/wp\/v2\/comments?post=8860"}],"version-history":[{"count":14,"href":"https:\/\/accompagner.be\/fr\/wp-json\/wp\/v2\/pages\/8860\/revisions"}],"predecessor-version":[{"id":13212,"href":"https:\/\/accompagner.be\/fr\/wp-json\/wp\/v2\/pages\/8860\/revisions\/13212"}],"wp:attachment":[{"href":"https:\/\/accompagner.be\/fr\/wp-json\/wp\/v2\/media?parent=8860"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}