Please fill in all fields of the form, and make sure they are certain and correct. (Please DO NOT use symbols like & # / \ { } etc. in all following fields.)
Program (choose the appropriate)
6-months intense pre-medical programApril 2025 - September 2025
1-year pre-medical programOctober 2025 - June 2026
Personal Data
Title (Mr/Ms/Miss/Mrs etc.)
Surname
Family Name (if used)
First Name(s)
Father's First Name
Mother's First and Maiden Name
Date of birth (year/month/day in format yyyy/mm/dd )
Place of birth (Country, City)
Citizenship
Nationality (optionally)
Face Photo
Please prepare your photo in electronic version on this computer
or on the pen-drive you can already use.
The available file format: .jpg .jpeg .png .xpng
and preffered color photo 2:3 30x45mm
with maximum file size of 1MB.
Please select a photo file and preview result:
By sending the above photo file, you agree and give exclusive permission for Medical Sciences Faculty to use your photo in all parts of internal application, and future study activities, include personal identification and control. At any time, you can request its deletion.
Passport Information
Passport Country
Passport Number
Date of Issue (year/month/day in format yyyy/mm/dd )
Date of Expiry (year/month/day in format yyyy/mm/dd )
Issuing Authority
Contact Information
Permanent Address
Correspondence Address (if different)
Street and No
Street and No
City
City
Postal/Zip-code
Postal/Zip-code
Country
Country
Telephone (please type only digits)
E-mail (please type in both fields exactly the same string)
Language Proficiency Information Please choose the appropriate
English is my first language
I attended a high school / promedical college in an English-speaking country prior to admission
English is not my first language (you need to submit proof of your proficiency in English)
Financial Support
How do you intend to finance your studies? (Personal savings, Private sponsor, etc., max. 100 characters)
Please give details of any loans or grants you are applying for, or have already secured. (optionally only, max. 100 characters)
Declaration
I consent to the collection and processing or relevant personal data by the University of Warmia and Mazury. I understand that the information provided on this form will be held and used for the purpose of processing my application for study and for student administration. All information on this application and appended thereto is protected by the Polish data protection laws.I certify that the information I have given on this application form is complete and accurate.
I agree to all the above
Sending date
Check all fields of this form before sending
If you want to keep a copy, please print it before sending
For further issues, please contact to: studyingmedicine@gmail.com
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