Egyptian Association For International   

  Medical Studies (EAIMS)

   Cairo - Egypt

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Sharing International Medical Experience

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Clinical Clerkships Programs (CCP)

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

Application Form (AF)

 

 Applicant's Personal Info:                                        

Full Name:

Nationality:

Passport Number:

Passport Valid Till:

Gender:

Date of Birth:

Place of Birth:

 Applicant's Study Info:                                             

Field Of Study:

Degree Of Study:

Faculty and University of Study:

 

 

Address and Contact Info of

Faculty and University of Study:

 

 

Study Language:

Native Language:

Other Languages:

 Applicant's Mailing and Electronic Info:                 

 

Street Address:

 

City:

State:

Postal/Zip Code:

Country:

Mobile Phone:

Home Phone:

Work Phone:

Fax:

Email:

 Applicant's Desired Clerkship Preferences:           

Field Of Clerkship:

 

Degree Of Clerkship:

 

Desired University Hospital:

  

 

Desired Departments or Subspecialties:

1-

2-

3-

4-

5-

6-

 

 

Desired Period from to

 

I Have Health Insurance Coverage For This Period :   Yes    No 

 

 

 Other Info:                                                               

How did you know about EAIMS?

 

 

Notes:

 

 

 

 

 

 

 

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