Saint Petersburg Medical University

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Medstudies Educational Online Application Form :

(If you are not able to send online click here to download our application form , take a print out and mail to us by post) If you should need Acrobat Reader to view PDF files, you can get it at http://www.adobe.com/products/acrobat
Course	BDS , MBBS (MD), PG
Medium	Russian , English
A. PERSONAL DATA :
Name:**
(IN CAPITAL LETTERS) (As recorded in your academic certificates)
Sex:
Date of Birth:
Age as on 31st December 2003 in completed years:
Mother tongue:
Nationality:
Marital Status:
Language Proficiency:
Write:
Read:
Speak:
Father's/Guardian's name and address:
Address:**
Telephone No.:**
E-mail:**
Passport Details:
Number:
Date of Expiry:
Date of Issue:
Issued at:
Address for correspondence:

Telephone No.:
Telex/Fax/E-mail :
Occupation of the Father/Guardian:

Annual income of father/guardian:
B. ACADEMIC PARTICULARS
Examination Passed	a. School Leaving Certificate	b. Higher Secondary/ Equivalent exam (12th grade)	c. Any Higher Examination
Name & Address of the School / college
Name of the University/Board
Regd. No.
No. of attempts for passing
Year of Passing
C. QUALIFYING EXAMINATION (Higher Secondary Course or Equivalent)
Name of the Examination Passed:
Name and Address of the Institution:
University/Board to which attached:
Total marks secured in all subjects:
Out of Maximum:
Percentage:
Marks obtained in the following subjects in the qualifying examination:
	Maximum Marks	Actual Marks Obtained	Percentage of Marks
Physics
Chemistry
Biology
Aggregate % in Physics, Chemistry & Biology
English
D. DECLARATION BY STUDENT
I have carefully read the instructions given in the prospectus and agree to abide by the decision of the University's authorities regarding my selection for the Course/programme. I certify that the particulars given by me in this application form are true to the best of my knowledge and belief.
Place:**
Date:**
Columns marked with ** Must not be left blank.