Application form for elective training programme for International Medical Student

To be completed and referred to

International Cooperation Department

Hanoi Medical University

No. 1 Ton That Tung , Hanoi, Vietnam.

Tel: + 84-4-8524000, + 84-4-8523798 ext 116

Fax: + 84-4-8525115, + 84-4-8524000

Website: http://www.hmu.edu.vn

Please read the instructions before completing this form

Instructions:

1. The Programme is provided in both clinical and non-clinical departments so that the student can increase his knowledge in any specific field of interest. All our
clinical departments and non-clinical departments are fully-equipped and provide a good opportunity to study.

2. To be admitted to the University for an elective course, you need to send us an application form, your CV, a recommendation letter signed by your President or Dean
of your University.

3. Administration fee of USD 30 will be charged on arrival (at the latest).

4. Students are required to contribute a tuition fee, based on the duration of their study (300 usd/month). No tuition fee is required for students belonging to a student
exchange programs signed between their institution and HMU.
5. Students will have to be responsible for their own transportation, food, accommodation etc. However, staff of international cooperation department will help them if
requested.

6. The acceptance letter from the Rector constitutes the final decision the elective request.

7. Evaluation of the students’ progress during their elective period may sometimes be issued.

8. Presentation and writing in a brief article for the University’s newsletter would be much appreciated.

9. The vacinnation injection is not required by Hanoi Medical University but strongly recommend to international students.
Application form for elective training programme for
International Medical Student

 Are you an Exchange student? Yes No

 Are you a non-exchange student? Yes No
 Indicate subjects you apply for:
 How long would you like to stay at HMU:
Please write in capital letters clearly

 PERSONAL INFORMATION
1. Name:
First Middle Last (Family)

2. Mailing Address 4. University Address for Official Transcript:

Name:
Tel: Fax:
Email:
Phone No.
3. Permanent Address 5. Place of Birth:
(city) (country)
6. Sex: Male Female

7. Date of Birth:
Day Month Yr.
Phone No.
8. Nationality:
9. Passport No. :
 10. E-mail Address:
 ACADEMIC INFORMATION  REQUIRED DOCUMENTS FOR ADMISSION
(FOR BOTH EXCHANGE AND NON-EXCHANGE STUDENT)
 Current Class standing:
1. Application form
Undergraduate Postgraduate
2. CV
 Please write what year you are in:
3. One recommendation letter
 Major :
4. A brief essay describing plan of study
5. Administration fee of U.S. $30

Date: ____________________________ Signature: _______________________________