[
Home
]
[ فارسی ]
Apply to Gonabad UMS
Tracking code of this form:
P16-F20-U0-N3575
[
Print the form
]
(
*
) indicates required fields
Application For Admission
1
Title
Select from list
Please Select...
Mr
Mrs.
Miss.
Ms.
2
Last Name:
*
Enter answer in the box
3
First Name:
*
Enter answer in the box
4
Middle Name:
Enter answer in the box
5
Gender:
*
*
Male
Female
6
ID NO:
Enter answer in the box
7
Field of study requested :
Select from list
Please Select...
Medicine (MD)
Intensive Care Nursing (MSc)
Nursing Education (MSc)
Community Health Nursing (MSC)
Special Care Nursing (Msc)
Health Education and Health promotion (MSc)
Environmental Health (MSc)
Laboratory Sciences (BSC)
Radialogy (BSC)
Midwifery (BSC)
Nursing (BSC)
Anesthesia (BSC)
Operating Room (BSC)
Public Health (BSC)
Environmental Health (BSC)
Occupational Health (BSC)
Emergency Medial Services (ASc)
Oral Health Technician (ASc)
8
Date of Birth:
Please enter gregorian date:
9
Country of Birth:
*
Enter answer in the box
10
City of Birth:
*
Enter answer in the box
11
Country of Residency:
*
Enter answer in the box
12
Marital Status:
Select from list
Please Select...
Married
Single
Divorced
Windowed
Contact Details
13
Mailing Address :
*
14
Postal Code :
Enter answer in the box
15
Town/City :
*
Enter answer in the box
16
State :
Enter answer in the box
17
Country :
*
Enter answer in the box
18
Cell Phone :
*
Enter answer in the box
19
Work Dial :
Enter answer in the box
20
Home Dial :
*
Enter answer in the box
21
E-mail Address :
*
Enter answer in the box
22
Work/Home Fax :
Enter answer in the box
23
Program Name :
Select from list
Please Select...
Degree Program
Non-degree Program
24
School :
Select from list
Please Select...
Medicine
Nursing and Midwifery
Health
Allied Medical Sciences
25
Degree :
Select from list
Please Select...
MD
MSc
BSc
ASc
Academic qualification & Work History
26
Please attach your C.V. and resume in support of the details provided.
*
Upload File
Allowed extensions : doc,docx,pdf,rtf,xls,ppt,jpg,gif,png - Allowed file size : 30000 KB
Declaration
- I have fulfilled all requirements required to be eligible for consideration.
- To the best of my knowledge, the information given in this application is correct and complete.
- I understand that submitting false or misleading information may result in any offer of a place withdrawn at any stage, including after a course has commenced.
- I understand that the University reserves the right to vary or reverse any decision made on the basis of incorrect or incomplete information.
- The University is under no obligation to consider an application submitted after the due date.
- I acknowledge and accept the full enrolment terms and conditions that govern this application form.
- I understand that Gonabad University of Medical Sciences collects, stores, and uses personal information in accordance with the University's Privacy Policy.
Persian site map -
English site map
- Created in 0.072 seconds with 822 queries by yektaweb 3388
