Lugansk State Medical University

Application form

APPLICATION FORM

Please fill application form and send it via e-mail or fax.

You can download application form here.

APPLICATION FORM

FOR ADMISSION AS A STUDENT AT LUGANSK STATE MEDICAL UNIVERSITY

Family name or Surname (block letters):
Other names:
Date of Birth:	DD/MM/YY
Country of Birth:
Nationality:
Country of normal residence:
International Passport Number:
Issued on:
Valid to:
Correspondence address:
Telephone:
E-mail:
Home address if different from above:
Educational background (indicate the educational institution, years of attendance and degrees/certificates obtained):
Grade Point Average:
Faculty or Department by which you wish your application to be considered:
Degree or other qualifications which you wish to obtain from LSMU:
Language of instruction: