Study abroad application form for Medical Study 

Language of Instruction              English

                                                 Latvian

 

Application For                                DOCTOR OF MEDICINE

                                                            DOCTOR OF DENTAL SURGERY

                                                            MASTER OF PHARMACY

                                                            SPECIALIST IN ERGOTHERAPY, B.Sc.

                                                            SPECIALIST IN PHYSIOTHERAPY, B.Sc.

                                                            Please, tick (x) the appropriate box

 

To Begin Studies                          :  January 2006/ September 2005

                                                       (underline the admission date)

 

1.Type or block print all information.

2. These items should be attached to the application:

             1) Official transcript from your High School / Higher 

                  Secondary School Leaving Certificate & Mark       sheet                                         

           2) 2 letters of recommendation.

           3) 8 photos in size 4x6 cm, 6 photos in size 3x4 cm

           4) Health Certificate.      

 

 

 

 

PHOTO

 

 

             5) Police Clearance  Certificate.

             6) Photocopy of passport(all pages).

             7) Photocopy of birth certificate.

             8) Affidavit of financial support.

             9) English Language Proficiency Evidence (for Students

                 applying in English Medium)     

Documents in origin must have an authorized translation in English.

Documents 1)4)5)8) must be legalized by the Ministry of  External Affairs and the Embassy of the country of origin to the Republic of Latvia.

3. Submit all application materials to: Study Abroad

OR   Your local representative or directly to the:  

           www.studyabroad.itgo.com

 

 

                                

Deadline: July 1, 2004 (for September, 2004 admission)

                 November 1, 2004 (for January, 2005 admission)

 

4. SIGN THE APPLICATION  ON  PAGE 2.

 

______________________________      _____________________________    ____________________

Family Name                                                    First Name                               Middle Name

 

______________________________      Day:______ Month______Year_____  _____________________

Mother's Maiden Name                                    Birthdate                                      Age/ Sex

 

______________________________       __________________  _________________   _____________

Birthplace (City,Country)                                Citizenship           Nationality            Passport Code,No.

 

Permanent Adress:______________________________________________________________________

                          No.  Street             City/Town                        Postal Code                   Country

 

Phone /FAX at Perm. Adress:_______________________________________________________________

 

FAX__________________________________________________________________________________________

 

e-mail_________________________________________________________________________________________

 

PERSON  TO NOTIFY     ___________________    ______________________  ______/____/____/_____

IN AN EMERGENCY:     Name                                           Relationship                               Daytime Phone

____________________________________________________________________________________

Address (No., Street, City, Postal Code, Country)

 

 

1. ACADEMIC RECORD

List all schools attended    

                                                Dates Attended                                    Diploma/                                Date of

Name of School    Location          From            To                 Certificate                    Graduation

_____________     _________   ________    ________         ______________            _____________

 

_____________     _________   ________    ________         ______________            _____________

 

_____________     _________   ________    ________         ______________            _____________

 

2. Date and place of matriculation:

__________________________________________________________________________________

 

3. Activity following matriculation if any: _______________________________________________

 

__________________________________________________________________________________

 

4. What is your mother tongue?_________________________________________________________

 

Other languages (level)?_______________________________________________________________

 

5. Personal information:

 

Your Marital state _______________________

 

Father's name _______________________________________________________________________

 

Occupation  _________________________________________________________________________

 

Address ______________________________________________________________________________

 

Mother's name __________________________

 

Address ______________________________________________________________________________

 

Certification: I hereby certify that all information provided by me in this application is accurate and complete.

 

Signature ____________________________               Date: ____________________________________