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Application Form for International Students 2023/2024

Faculty of Medicine, University of Banja Luka

Study programme of Medicine

Personal Information

First name *
Middle name
Last name *

1. Applying for the Study Programme: *

2. Male/Female *

Contact Information

3. E-mail Address *

4. Current Mailing Address Street *

5. City, Municipality *

6. Country *

7. Current Telephone Number *

8. Other Telephone

9. Parents Mailing Address (Street, City, Country) *

Father

10. Father's First Name *

11. Father's Last Name *

Mother

12. Mother's First Name *

13. Mother's Last Name *

14. Mother's Maiden Name

Place of Birth, Date of Birth

15. City *

16. Municipality *

17. Country of Birth *

18. Date of Birth (dd/mm/yyyy) *

19. Citizenship *

Passport

20. Passport Number

21. Place of Issue - City

22. Place of Issue - Country

23. Issuing Country

24. Issuance Date

25. Expiration Date

Academic History - Middle and High School

26. Secondary/High School (dates from - to, school attended) *

Secondary/High school (including country) Date from (dd/mm/yyyy) Date to (dd/mm/yyyy)
Add another filed

27. Have you ever matriculated in or attended any medical school? *

28. Declaration and Signature *

I certify that the information submitted in this application is complete and accurate to the best of my knowledge. I understand that any false or misleading information supplied will be grounds for withdrawing any acceptance or future dismissal from the Faculty of Medicine, University of Banja Luka. Should any information in this application change, I understand my obligation to notify the Faculty of Medicine, University of Banja Luka immediately.




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