Application Form for International Students

Faculty of Medicine, University of Banja Luka

Study programme of Medicine

Kонтакт подаци

Име *
Средње име
Презиме *

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)
Додај још поља

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.



* Oбавезно питање

 



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