• Year-Applying for
  • Full Name*
  • Medical Title*
  • Address*
  • Phone Number*
  • Email Address*
  • Name of Medical College*
  • Name of the University*
  • Address of Medical College*
  • Date of starting Medical Education*
  • Date of completing Medical Education*
  • Have you met all requirements for your MBBS*
  • If not, when will these be completed including Internship*
  • Are you interested in Research?*
  • If yes-what sub-specialty of Internal Medicine Interests you the most?
  • Do you have research experience?*
  • If yes - please explain in brief.
  • USMLE
  • Documents Submitted [Tick all that are attached]*
  • If your documents or letters of recommendation are not in English, you must include a certified translation prepared by a professional translator.

  • Amount and Source of Funding US$ 85,500.00:

    List the amount of funding in U.S. Currency; if receiving funding from more than one source, indicate the amount received from each source. If using personal or university funds, you must provide original documentation of amounts listed (letters must be on letterhead and must be originals; personal funds may be verified with certified copies of bank statements. Please provide amounts in U.S. dollars on all documents.

  • Source of Funding*
  • If Other or Multiple sources: Please specify
  • Please provide the address and telephone number for the location to which your acceptance letter should be sent. Telephone numbers are required – all documents are sent via DHL International Express.

  • Address*
  • Phone Number*
    Country Code+City Code+Phone Number
  • E-mail address [Notification of shipment will be emailed]*
  • Acknowledgement

    I acknowledge that by signing this application, I am agreeing to the terms of the Post MBBS Research Training program and that all information contained herein and in any accompanying documents is true and correct.

  • Signed by:*
    Name
  • Date*
  • Signature
  • P L E A S E - N O T E

    The application form along with all requested documents must be e-mailed to drnctrust@gmail.com. A copy should be mailed/couriered to Dr. Nirmala Swami Charitable Trust, Orthopedic Hospital, Sayajigunj, Baroda, 390 005, Gujarat, INDIA.

  • Security Code*

     

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