Application

for Master Programme in Public Health

Fill in all the fields on computer or in hand-printing characters.

1. Personal information
Last name / Sex: / male female
First name / Date of birth:
Second name / day/month/year
Home address:
Town, postcode: / Country:
Correspondence address:
Town, postcode: / Country:
Home telephone: / Mobile telephone:
E-mail address:
2. Higher Education
First higher education:
University/Academy/Institute:
Faculty:
Speciality:
Date of graduation:
Second higher education (if applicable):
University/Academy/Institute:
Faculty:
Speciality:
Date of graduation:
3. Employment
Place of work/studies:
Position:
Year and month of employment onset:
Address of employer:
Town, postcode: / Country:
Working telephone:
4. Proficiency in English
Please, closely read through all the offered statements and comments to them. Choose the option which suits you best.
 / High level of the English language that is documented by internationally approved English language test
If you have chosen this option you are to attach the copy of TOEFL, Cambridge or MELAB certificate to the application form.
 / High level of the English language that is not documented by internationally approved English language test
The choice of this option presumes that you are ready to take a test in the English language at admission to the studies.
5. Necessary attachments to the application
There must be attached: copy(ies) of diploma(s) of higher education and copy of passport.Mark the names of the documents you have attached.
 / Copy(ies) of diploma(s) of higher education
 / Copy of passport (pages with photo and registration)
6. Additional information
If you consider important to present a more detailed information about yourself, your education and professional experience, please, do it in the form of attachment to the application (not more than one page).
7. Consent to the processing of personal data
I hereby consent to the processing of my personal data referred to in this application
Date:______Signature:______
8. Date and signature
Date: / Signature:

Please submit your application electronically to or by fax to the number +7 (8182) 263226.