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Application Form for International Students 2022/2023

Faculty of Medicine, University of Banja Luka

Study programme of Medicine

Osebni podatki

Ime *
Srednje ime
Priimek *

1. Male/Female *

Contact Information

2. E-mail Address *

3. Current Mailing Address Street *

4. City *

5. Country *

6. Current Telephone Number *

7. Other Telephone

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

Father

9. Father's First Name *

10. Father's Last Name *

Mother

11. Mother's First Name *

12. Mother's Last Name *

13. Mother's Maiden Name

Place of Birth, Date of Birth

14. City *

15. Country of Birth *

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

17. Citizenship *

Passport

18. Passport Number

19. Place of Issue - City

20. Place of Issue - Country

21. Issuing Country

22. Issuance Date

23. Expiration Date

Academic History - Middle and High School

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

Secondary/High school (including country) Date from (dd/mm/yyyy) Date to (dd/mm/yyyy)
Dodaj drugo polje

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

26. 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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