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SEMMELWEIS UNIVERSITY FACULTY OF HEALTH SCIENCES

PHOTO (signed)

Clip. Do not glue,

tape or staple

B.SC. AND M.SC. PROGRAMS IN ENGLISH

APPLICATION FORMTo Begin Studies in September 2013

1. Type or block print all information.

2. These items should be attached to the application:

Required documents

Completed Application Form

Application Fee of 200 EUR

Test Fee

Secondary School Leaving Certificate

Medical Certificates (in English): general medical report, HIV test result,

Hepatitis B vaccination certificate, a chest X-ray result

Five Signed Photographs

Copy of Passport/ID card

Letters of Recommendation

Please note that the Faculty accepts only:

the original English document OR the attested copy of the original English document OR

the authorized English translation of the original non-English

document.

3. Sign the application form on page 2.

4. Submit all application documents to your local representative:

Deadline for application: August 15, 2013*

Preferred location of the aptitude test:

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If no otherwise indicated send it directly to Semmelweis University Faculty of Health Sciences,International Students Secretariat (H-1088 Budapest, 17 Vas str., Hungary), or to the Student Service Center

(College International, H-1406 Budapest 76, P.O. Box 51, Hungary).

I apply for Physiotherapy B.Sc. Nursing B.Sc. Midwifery B.Sc.

Please, tick () the appropriate box.

Family Name (Surname)

First Name (Given name)Please, write your name as written in the passport.

Sex (F/M) Birthdate (D/M/Y) Birthplace (City / Country) Passport / ID card No.

Citizenship** Mothers full maiden name

Permanent Address (No. / Street / City / Town / Postal Code / Country)

Phone/Fax at Perm. Address E-mail

* Applicants turning in their applications between 16/08/2012 till the end of zero week in semester 2013/14/1 have

to pay EUR 200 extra fee.

** If you have a dual citizenship please underline the country, whose passport you will use during your stay on Hungary.

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ACADEMIC RECORD

1. List the details of your previous studies

Name of secondary school:

Location:

Dates: (from to)

Certificate:

Date and place of secondary school leaving exam:

Certificate issued by:

Certificate no.:

Main studies: (please underline) Biology Chemistry Physics

Activity after graduation if any:

2. What is your mother tongue?

Other languages? Speak: Read: Write:

Hungarian? Speak: Read: Write:

PERSONAL INFORMATION

3. Your marital status

4. Fathers full name Occupation

Address

Mothers maidenname Occupation

Address

5. Person to contact in case of emergency:

Name Relationship Daytime Phone

Address (No. / Street / City / Postal Code / Country) Daytime Fax

6. CURRICULUM VITAE.Attach separate page

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

that I am fully aware of the contents of the official English language brochure of Semmelweis University

Faculty of Health Sciences, and fully accept the given conditions.

(Signed) Date:

Where and how did you firstlearn about this program (please, specify):

Where else did you get further information from:

www.se-etk.hu local representative www.studyhungary.hu educational fair/seminar

a Budapest-student friend/relative my high school advertisement other