Application form

I. Personal details
First name		Last name
Gender	MaleFemale	Date of birth	D M Y
Country of birth		City of birth
Citizenship		Passport №
Passport is issued (date)		Passport is valid till (date)
Country of residence		Postal code
Street, №		City
Country		E-mail
Telephone		Fax
The country and city, where the nearest RF Consulate Department is located (to make an official letter of invitation)
Your occupation after school:		Place of work (if any)
Street, №		Postal code
City		Country
Telephone		Fax
Occupation

II. Education
Secondary level:
Name of School, Country, City Level Completed Year Completed Duration of Education Test results Post-secondary level: Name of School, Country, City Level Completed Year Completed Duration of Education Test results
Language skills:
Level of Russian	nonebeginnergoodexcellent	Level of English	nonebeginnergoodexcellent
Other languages

III. Medical Faculty of VSMA, you would like to study in:

General Medicine   Stomatology   Pediatrics   Pharmacy

IV. Who will pay for your education
Full name		Profession
Place of work:
Street, №		City
Country		Telephone
Fax		E-mail