APPLICATION FOR ADMISSION
Crimea State Medical University named after S.I.Georgievsky
2009/2010 academic year

BIOGRAPHICAL INFORMATION


First name:*
Last name:
Middle name:
Date of birth (DD-MM-YYYY):*

City, State, Country of birth:
Marital status:		Married Single
Citizenship:*
Gender:		Female Male

Permanent street address:
City:
Zip/Postal Code:
State:
Country:

Phone #:
Mobile #:
Office #:
E-mail:

ACADEMIC INFORMATION

Indicate the highest level of education you have earned:		Bachelor Master`s Doctoral
College/University Name:
Address:
Degree:
Completion Date (MM-YYYY):
Chemistry:
Physics:
Biology:
College/University Name
Address:
Degree:
Completion Date (MM-YYYY):
Years Attended:
Language 1:
Speaking ability:		High Moderate Low
Reading ability:		High Moderate Low
Writing ability:		High Moderate Low
Language 2:
Speaking ability:		High Moderate Low
Reading ability:		High Moderate Low
Writing ability:		High Moderate 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

University Office:

Address: Ukraine, 95006, Simferopol, 5/7, Lenin Avenue
Tel.: +38(0652) 254-711, 294-804, 294-978

Fax: +38(0652) 271-547, 272-092

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APPLICATION FOR ADMISSION Crimea State Medical University named after S.I.Georgievsky 2009/2010 academic year

APPLICATION FOR ADMISSION
Crimea State Medical University named after S.I.Georgievsky
2009/2010 academic year