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Application Form


Family name:
 
First name(s):
 
Male / Female:
Date of birth:
 
Home address:
 
City:
 
Zip code:
 
Country:
 
Telephone number at home:
 
Fax at home if available:
 
E-mail address:
 
I am a student from:
 
University [Medical School]:
 
The Dean of our Medical School is:
 
The length of our medical curriculum is (years):
 
I am in the (year of my medical training):
 
I have understood that the meeting language is English, and I confirm that I speak English quite well.
What is your level of English? For example: the mark you've got for English on High School (1 - 10 or F - A). Or did you follow an English Course (IELTS, TOEFL, etc)
 
Special dietary requests:
 
My motivation for participating (50-100 words):
 
How did you find out about the summer school?
Surfing the Internet
A poster from the Faculty of Medical Sciences
Through the International Federation of Medical Students Associations (IFMSA) network
Through the European Medical Students Associations (EMSA) network
A friend who visited a summer school in the past
Study Abroad
Other:
Please specify.....
 

Please send your passport photograph with your name and address separately to: ssgh@ifmsagroningen.nl  
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