Application

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*Program (choose the appropriate)

Six year MD Program Four year Medical degree

Personal Data

Male/Female

Male Female

*Title

*Name

0/50

Middle Name

0/50

*Last Name

0/50

Fathers First Name

0/50

Mothers First Name

0/50

*Date of birth

*Place of birth

*Citizenship

Passport information

*Passport Country

0/80

*Passport Number

0/8

*Date of issue

*Date of expire

*Issuing Authority

0/80

Contact Information

Permanent adress in Home Country

*Street and number

*City

0/60

Postal/ZIP code

0/20

*Country

0/80

*Email adress

*Telephone/mobile/cell number

0/15

Stationary phone number (optional)

0/15

Correspodence adress (if different)

Street and number

City

0/80

Postal/ZIP code

0/20

Country

0/80

Language Proficiency Information

English is my first language

Yes No

Please choose the appropriate

Did you attend a high school/pre-medical college in an English-speaking country prior to admission?

Financial Support

How do you intent do finance your studies?

Please give details of any loans or grants you are applying for or have already secured

*I consent to the collection and processing or relevant personal data by the American Northwest University. 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 goverment data protection laws. I certify that the information I have given on tihis application form is complete and accurate.

I agree to all the above

Please attach the following

*Passport photoPhotocopy of passport photo

Photocopy of all school transcripts translated into English and stamped by Notary Public(max size: 1 Mb)

Photocopy of all graduate transcripts(max size: 1 Mb)

English language Certificate (if applicable)

Photocopy of passport page

Photocopy of bank statements of sponsor(max size: 1 Mb)

Photocopy of a document with tax return for the last two years of sponsor (if applicable)(max size: 1 Mb)

Affidavit from sponsor signed by Notary Public(max size: 1 Mb)

One essay question: 500 words: How do you envisage yourself in 6 year’s time?(max size: 1 Mb)

Fields with (*) are compulsory.

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