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                       DONETSK  NATIONAL   MEDICAL   UNIVERSITY
                                        16, ILLICHA AVENUE, DONETSK, UKRAINE

                                                         Fax +380 (95 7352869)                           

                                     E-mail:    admissions@dnmu.net

                            APPLICATION FORM

Surname: ____________________________________________________________________________

Name: ______________________________________________________________________________

Nationality: ___________________________  Date of Birth: __________________________________

Permanent Address: ___________________________________________________________________

Present Address: ______________________________________________________________________

Tel: __________________________________Fax: __________________________________________

E-mail: ______________________________ Sex: Male                   Female:       

Passport No.: ______________________ Date of Expiry of Passport: ___________________________

Marital Status: ________________________


Required Course:______________________________________________________________________


Academic Records:

Name of School/College/University with marks and grade details: _______________________________
____________________________________________________________________________________
____________________________________________________________________________________





Signature of Applicant: _______________________ Date : ____________________________________



For admissions we require filled application form, copy of international passport with copies of educational certificates. You can send these documents to us by e-mail or by fax.