Form - Application for Admission - Short Term Exchange Program - Medopolo International Medical Rotation Programs

Personal Data

Date of Birth

Valid till (Passport)

Emergency Contact Person

Planned Stay From: Until:

Home Institution / Medical School

International Office

Attachments

Upload Passport Scan* (JPG/JPEG/PNG, Max 5MB):
Upload Pass Photo* (JPG/JPEG/PNG, Max 5MB):
Upload Academic Transcript* (PDF, Max 5MB):
Upload CV* (PDF, Max 5MB):
Upload Motivation Letter* (PDF, Max 5MB):
Upload Recommendation Letter / Letter of Good Standing* (PDF, Max 5MB):
Upload International Health Insurance (PDF, Max 5MB):
Upload Immunization Record (PDF, Max 5MB):
Upload Additional Document (PDF, Max 5MB):
(*obligatory)