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Application for admission




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APPLICATION FOR ADMISSION


Crimea State Medical University named after S.I.Georgievsky

2011/2012 academic year


BIOGRAPHICAL INFORMATION

1. First name:

2. Last name:

3. Middle name:

4. Date of birth: MM-DD-YYYY

5. City, State, Country of birth:

6. Citizenship:

7. Marital status: Married Single

8. Gender: Female Male

9. Permanent street address:

10. City: 11.State: 12.Zip/Postal Code: 13. Country:

14. Phone #:

15. Mobile #:

16. Office #:

17. E-mail:

^ ACADEMIC INFORMATION

Indicate the highest level of education you have earned: [ ] Bachelor [ ] Master`s [ ] Doctoral

Undergraduate education

College/University Name:

Address:

Degree:

Completion Date (MM-YYYY):

Years Attended:




Final Results in




Chemistry:




Physics:




Biology:

^ Additional Education







College/University Name

Address:







Degree:

Completion Date (MM-YYYY):




Years Attended:







Language 1 ______







Speaking ability:

Reading ability:

Writing ability:

High

High

High

Moderate

Moderate

Moderate

Low

Low

Low

Language 2 ______







Speaking ability:

Reading ability:

Writing ability:

High

High

High

Moderate

Moderate

Moderate

Low

Low

Low

^ Other languages:

Please indicate the program at CSMU you apply for:

Pre-Medical Course – 8 months







“General Medicine” (MD, MBBS equivalent ) – 6 years

“Dentistry” (MD, MBBS equivalent) – 5 years

Post-graduate course (indicate):

I am agree with the terms and rules of admission at Crimea State Medical University named after S.I.Georgievsky (CSMU) in 2009/2010 academic year

Signature


Note: To receive the original CSMU invitation letter with your name by specialized post please attach to this application letter: 1.Scanned copy of your national Passport (1 page, 1 file), 2. Scanned copy of your school certificate with obligatory results in Chemistry, Physics and Biology

Application form and documents attached should be e-mailed: m2m@csmu.strace.net

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