BMEP - Biomedical Education Program
Who can apply
How to apply
imprint/ legal notice
How to apply
19th of July 2019
(family name in capital)
Present mailing address (for correspondence)
(postal code, city)
(Birth date and place)
common law marriage
Name and address of relatives who should be informed in case of emergency
Bank account number
Further approved funding (Rotary, private funds etc.)
Student of (discipline, e.g., medicine)
First (medical) major (e.g. Physikum)
(date and results)
State examination (date and results)
(if not yet taken, please indicate expected date)
Have you started your Doctoral Thesis?
If YES, Subject of Doctoral Thesis work
Name of Home Mentor (if not Thesis Supervisor):
Mentor in Host Institution:
Are you interested in Clinical Rotations during your stay at your Host Institution?
If YES, can the clinical rotations be organized through your Host Mentor?
If NO, why not
Additional Information regarding Host, Host Institution and/or Host City
Estimated Costs of Exchange (required by US immigration):
Available support from personal funds
Extracurricular activities, interests and hobbies
Does your medical school require a report on your elective studies?
(letter of reference, school report, etc.)
If you are a human, leave this field empty