Form – Application for Admission – Short Term Exchange Program Personal Data Date of Birth Valid till (Passport) Emergency Contact Person Planned Stay Destination Botucatu Zanzibar ZanzibarNursing SriLanka Damongo Altwarp From: Start date must be at least 30 days in the future. Until: End date must be after start date. Program Type Medical Elective Internship Home Institution / Medical School International Office Attachments Upload Pass Photo* (JPG/JPEG/PNG, Max 5MB): Upload Passport Scan* (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)
