Ternopil State Medical University

Application Form

Surname
Name
Middle name
Date of Birth (date/month/year)
Gender
Passport number
(passport) Issued on (yyyy/mm)
(passport) Valid till (yyyy/mm)
Home address
Correspondence Address (mailing) address if
different from above
Country where you are planning to apply for
Ukrainian Visa
Telephone number ( including country code )
Fax number ( including country code )
Mobile phone number
e-mail address
Availability of secondary(high) school or
college education
Documents which can prove your level of
education
Which course you would like to enroll in





Postgraduate (please specify)
Language of instruction


Passport photocopy
Copy of the document which can prove your level
of education (high (secondary) school or
college
certificate)1
Copy of the document which can prove your level
of education (high (secondary) school or
college
certificate)2
Date dd/mm/yyyy
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