Egyptian Association For International   

  Medical Studies (EAIMS)

   Cairo - Egypt

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Clinical Clerkships Programs (CCP)

(Human Medicine - Dentistry - Pharmacy - Physiotherapy - Nursing)

Application Form (AF)

 

 Applicant's Personal Info:                                        

Family Name  :

First Name  :

Nationality :

Passport Number :

Passport Valid till :

Gender :

Date of Birth  :

Native Language :

Other Languages :

 Applicant's Study Info:                                             
Field Of Study :
Degree Of Study :
Faculty and University of Study:

 Applicant's Mailing and Electronic Info:                 

Street Address:

City:

State:

Postal/Zip Code:

Country:

Mobile Phone:

Home Phone:

Fax:

Email:
 Applicant's Desired Clerkship Preferences:           
Field Of Clerkship :

 
Degree Of Clerkship :

 

Desired Subspecialties or Departments :

1-

2-

3-

4-

5-

 

Desired Period from to

 

I Have Health Insurance Coverage For This Period :   Yes    No 

 
 Other Info:                                                               
How did you know EAIMS ?

 

 

Notes :

 

 

 

 

 

 

 

Clinical Clerkships Programs (CCP)

(Human Medicine - Dentistry - Pharmacy - Physiotherapy - Nursing)

Card of Confirmation (CC)

 

 Applicant's Personal Info:                                        

Family Name  :

First Name  :

Nationality :

Passport Number :

Passport Valid till :

Gender :

Date of Birth  :

Native Language :

Other Languages :

 Applicant's Study Info:                                             
Field Of Study :
Degree Of Study :
Faculty and University of Study:

 Applicant's Mailing and Electronic Info:                 

Street Address:

City:

State:

Postal/Zip Code:

Country:

Mobile Phone:

Home Phone:

Fax:

Email:
  Applicant's Confirmation/Cancellation:          

 

I hereby my program in at for the period from to .

 

Arrival :

I will arrive by on at to

I can not state the exact date of my arrival .
 Other Info:                                                               

Notes :

 

 

 

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