PERSONAL DETAILS

Name *

Nationality *

Gender *

Date of Birth *

Passport No *

Address *

(For Future Correspondence)

Contact No *

E-mail Address *

Photograph (Passport Size) *

ELECTIVE APPOINMENT DETAILS

Select the appointments you wish to do in the order of preference and the dates.

Weeks

From     To  

Weeks

From     To  

Weeks

From     To  

Weeks

From     To  

Weeks

From     To  

Weeks

From     To  

Weeks

From     To  

Weeks

From     To  

Total Number of Elective 

Weeks *

ABOUT YOUR HOME INSTITUTION

Name of Your University / Medical School *

(Include the Address)

Present Year of Study *

Total Duration of the Medical Course *

OTHER REQUIREMENTS

Please send via e-mail the following documents (electives@sjp.ac.lk);

1. a covering letter stating the elective appointment(s) you wish to do with the dates
2. PDF of the completed online application (check submission confirmation e-mail)
3. resume or a brief curriculum vitae
4. a letter from the Medical School / University confirming your medical studentship and giving permission to do an elective

Please complete all sections before you click submit.