Program
(choose the appropriate) |
6 years MD Program
transfer from ext. university program | 6 years MD/PhD Program
3 years PhD Program |
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Personal Data
(please DO NOT use symbols like & # { } etc. in all following fileds) |
Male Female Title (Mr/Ms/Miss/Mrs etc.)
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Surname
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Family Name
| First Name(s)
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Father's First Name
| Mother's First and Maiden Name
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Date of birth (day/month/year)
| Place of birth (Country, City)
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Citizenship
| Nationality (optional)
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| Passport Information |
Passport Country
| Passport Number
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Date of Issue (day/month/year)
| Date of Expiry (day/month/year)
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Issuing Authority
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| Contact Information |
Permanent Address
| Correspondence Address (if different)
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Street and No
| Street and No
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City
| City
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Postal/Zip-code
| Postal/Zip-code
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Country
| Country
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Telephone (please type only digits)
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E-mail (please type in both fields exactly the same string)
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Education
Please give names of all educational institutions attended |
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Language Proficiency Information
Please choose the appropriate |
English is my first language I attended a high school / promedical college in an English-speaking country prior to admission English is not my first language (you need to submit proof of your proficiency in English) |
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| Financial Support |
How do you intend to finance your studies? (Personal savings, Private sponsor, etc.)
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Please give details of any loans or grants you are applying for or have already secured. (optionally only, max. 100 characters)
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| College accomodation |
Do you intend to apply for college accomodation?
No
Single room Double room
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| Declaration |
I consent to the collection and processing or relevant personal data by the University of Varmia and Masuria. I understand that
the information provided on this form will be held and used for the purpose of processing my application for study and for student administration. All information on this application and appended thereto is protected by the Polish data protection laws.I realize that the studies at Faculty of Medical Sciences at the University of Varmia and Masuria are at own expense. I certify that the information I have given on this application form is complete and accurate. |
I agree to all the above
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Signature
| Date (day/month/year)
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| Additional Information |
How did you hear about University of Varmia and Masuria? (optionally only)
Internet
Prospectus
Recommendation
Visit
Other (max. 100 characters):
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| Document checklist |
| | document name: |
| | Application form |
| | Health Certificate completed by a doctor |
| | Original of birth certificate or a copy certified by a public notary and an English or Polish translation by a sworn translator |
| | A certified by the Polish Consulate original High School Diploma (Secondary School Certificate) or other document (with a clause proving the right to apply for admission to higher education institution in the country where the certificate was issued) recognized as equivalent to the Polish general certificate of secondary education and an English or Polish translation by a sworn translator |
| | Four photographs (35 x 45 mm), against a light background, taken without headgear and one photograph in electronic version (PNG, JPG, BMP file, size 300 x 375 pixels, image resolution not lover then 300 dpi) on an electronic media (e.g. CD) |
| | A certified photocopy of a valid passport (the page with photo) |
| | Proof of the payment of the admission fee |
| | Certificate of Proficiency in English (e.g. IELTS - 5.5) |
| | Proof of health insurance valid in Poland (European Union citizens- EHIC card) - after admission |
| | A copy of students visa - after admission |
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If you have a printer connected or available, please print out all 3 pages (background shadows are not a matter).
It's optional only, but it's good to keep the printed pages for future use.
To send this application form:
please click the button below
ONLY ONE TIME
then wait a while for reply confirmation
continue on this web page.
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| Copyright ©2011 University of Varmia and Masuria. Faculty of Medical Sciences. |
