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APPLICATION FORM

FOR TROPICAL MEDICINE AND INFECTIOUS DISEASES ELECTIVE


 

PERSONAL DETAILS

NAME

NATIONALITY

GENDER

DATE OF BIRTH

PASSPORT NO

ADDRESS (For Future Correspondence)

CONTACT NO

E-MAIL ADDRESS (Please Print Clearly)

PHOTOGRAPH (Passport Size jpg or png)

 

 

EELECTIVE ATTACHMENT DETAILS

DATES AVAILABLE

 

 

ABOUT YOUR HOME INSTITUTION

NAME OF YOUR UNIVERSITY/MEDICAL SCHOOL

(Include the Address)

PRESENT YEAR OF STUDY

TOTAL DURATION OF THE MEDICAL COURSE

 

 

FEES

Tropical medicine and infectious diseases elective students are required to pay a fee using online payment gateway as follows:

  • US$ 350 for 3 weeks Tropical medicine and infectious diseases elective
  • US$ 500 for 5 weeks Tropical medicine and infectious diseases elective

 

 

OTHER REQUIREMENTS

A brief CV and a letter from your university/medical school confirming the studentship and approving the elective attachment should be sent via e-mail to the elective coordinator (electivecoordinator.srilanka@gmail.com).


Please complete all sections before you click submit.

 

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