Local Representative: Recruitment (XLNC), Application to Faculty of Medicine, UPJS in Kosice,
Matuskova 18., 04011 Kosice, Slovak Republic
 
APPLICATION FOR ADMISSION TO UNIVERSITY
for the academic year 2015/2016
(Prihláška na štúdium na VŠ na akademický rok 2015/2016)
To be submitted to the adress above, together with the documents listed at www.medicinekosice.eu
 
Branch of study (odbor)    
General Medicine (všeobecné lekárstvo)  
 
  Dental Medicine (zubné lekárstvo)  
 
Surname (priezvisko):
First Name (meno):

Date of birth
(dátum narodenia)  
Day (deň): Month (mesiac): Year (rok):
Place of birth (miesto narodenia):

Sex (pohlavie): male female   Marital status (stav): sinle married divorced

Nationality (národnos'):   Citizenship (štát.obč):
Passport number and state (č.pasu+štát):
Mother's name :
Father's naem :

Permanent address (adresa trvalého bydliska):  
Street, number (ulica,č.domu):  
Postcode (PSČ):  
  Town/City (mesto):  
Country (štát):
Phone:
E-mail address (please double check!):

Completed secondary school (absolvovaná stredná škola):
Name of school (názov školy):
Address (adresa):  
Year of Maturity leaving exam (rok maturity):

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