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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) | ||
|---|---|---|---|---|
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.
