Application

1.Personal Information

Family Name

First Name

Your email

Nationality

Passport Number

Gender
MaleFemaleOthers

Date of Birth

2. Education and University Details

Name of University

University Address

Country

Current year at university

Level of Graduate

3. Planning for Enrollment

Faculty
MedicalNursingRadiologyRadiographyPharmacyDentalPhysiotherapy

Preferred Departments (You should stay in one department for at least two weeks)
a. Department

Start Date

End Date

b. Department

Start Date

End Date

Desire type if Clerkship
Pre-clinical ClerkshipClinical Clerkship

Please attach following documents in a single pdf file
1. Letter of Intent (not exceeding one page)
2. Curriculum Vitae.
3. Letter of bonafide student duly signed by the Dean/Vice-Dean or Registrar of the
Medical School.

Documents as above (size limit 4 MB)


Photograph (size limit 1 MB)