University of Warmia and Mazury
School of Medicine. Olsztyn. Poland.
Application form
Dean's Office Address:
University of Warmia and Mazury
Medical Faculty
Warszawska Street 30
10-082 Olsztyn, Poland

  Please fill in all fields of the form, and make sure they are certain and correct.
  (Please DO NOT use symbols like & # / \ { } etc. in all following fields.)

 (choose the appropriate)
6-years MD program
October 2020 - September 2026
transfer from ext. university
October 2020 - September 2026
 Personal Photo
 Face photo only

 Please prepare your photo in electronic version on this computer
 or on the pen-drive you can already use.
 The available file format: .jpg .jpeg .png .xpng
 and preffered color photo 2:3 30x45mm
 with maximum file size of 1MB.
 (The image will scale automatically
 but this can change the quality of origin)

 Please select/change a photo file (see preview):

By sending the above photo file, you agree and give exclusive permission for Medical Faculty to use your photo in all parts of internal application, and future study activities, include personal identification and control.
At any time, you can request its deletion.
 Personal Data
 Title (Mr/Ms/Miss/Mrs etc.)
Male Female
 First Name(s)
 Family Name
 Father's First Name
 Mother's First and Maiden Name
 Date of birth (year/month/day in format yyyy/mm/dd)
 Place of birth (Country, City)
 Nationality (optionally)
 Passport Information
 Passport Country
 Passport Number
 Date of Issue (year/month/day in format yyyy/mm/dd)
 Date of Expiry (year/month/day in format yyyy/mm/dd)
 Issuing Authority
 Contact Information
 Permanent Address
 Correspondence Address (if different)
 Street and No
 Street and No
 Telephone (please type only digits)
Mobile/cell phone numer,
(in int'l format +YY XXX XXXXXX...):
  Stationary phone (optionally only)
Country Code / Area Code / Number:
 E-mail (please type in both fields exactly the same string)
 Please give names of the latest educational institutions attended
Start Year
Year of completion
Field of study
School name and type
Location (Country, City)
Start Year
Year of completion
Field of study
School name and type
Location (Country, City)
 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)
 Financial Support
 How do you intend to finance your studies? (Personal savings, Private sponsor, etc., max. 100 characters)
 Please give details of any loans or grants you are applying for, or have already secured. (optionally only, max. 100 characters)
 College accomodation
 Do you intend to apply for college accomodation?
No Single room
I consent to the collection and processing or relevant personal data by the University of Warmia and Mazury. 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 Medical Faculty at the University of Warmia and Mazury 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
 Sending date
 Signature (only at the pre-printed form)
 Additional Information (optionally only for statistics)
  How did you hear about University of Warmia and Mazury?
  Other (max. 100 characters):
 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
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 - 6.5)
Proof of health insurance valid in Poland (European Union citizens- EHIC card) - after admission
A copy of students visa - after admission
  1. Please fill out the application form
  2. Push the below button to check and print out the form
  3. Sign the printed application form
  4. Push the SEND button to send the electronic version of the application form to our system
  5. Make a scan of your application form and other required documents and email them to the Admissions Office
      or to this email:
  6. Please bring the signed application form and the originals of the documents to the Entrance Exam
      or send the package to the Admission Office
      - Candidates from Saudi Arabia must include the currently authorized Saudi ID Card
     - Candidates from Scandinavia please send the signed application form and the originals of the documents to the Scand. Admission Office


 To send this application form:
 please verify CAPTCHA values
 and click the button below
 then wait a while for a reply confirmation
 continues on this web page.


Copyright ©2010-2019 University of Warmia and Mazury. Poland. Olsztyn. Medical Faculty.