APPLICATION FORM

1. Country: _____________________________________________________________________

2. Surname: ____________________________________________________________________

3. Name (underline the one often used):______________________________________________

4. Sex: male or female ____________________________________________________________

5. Date of birth: _________________________________________________________________

6. Place of birth: _________________________________________________________________

7. Permanent address: ____________________________________________________________

____________________________________________________________________________

8. Your profession and place of work or study at the moment of application: __________________

____________________________________________________________________________

____________________________________________________________________________

9. What language do you know? (English, French, Spanish, Russian)_________________________

To what extent do you know foreign languages? (Writing, reading, conversation)____________

____________________________________________________________________________

10. Mother language: _____________________________________________________________

11. Education (names of schools or colleges or university, place, date of entering and graduation or

Ceasing studying there. Certificates and their dates):

Primary school: _______________________________________________________________

Secondary school: _____________________________________________________________

University: ___________________________________________________________________

12. Subjects successfully passed:

ESTABLISHMENT SUBJECT DATE MARK

13. What levels of training do you want?

 Bachelor of Science/Arts: ________________

Master of Science/Arts: __________________

Residency (clinical studies) _______________

Post graduate (PhD course or Doctoral programme) __________

Short-term training (up to 1 year) ______________

Part-time training (5-10 months) _______________

14. What specialty do you choose to be trained in Russia and what educational establishment do you

prefer to enter?

(Code and full name of speciality)

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

15. Themes of your scientific work (for post-graduate studies):

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

16. Foreign passport: number No _____________ Date of expiry _________________

Date __________ Signature _______________