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INTERNATIONAL FEDERATION OF MEDICAL STUDENTS' ASSOCIATIONS
STANDING COMMITTEE ON PROFESSIONAL EXCHANGE
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APPLICATION FORM

Family name : Zochowska First name : Malgorzata Nationality :Polish Sex : Female Date of birth : 20-10-1988 Passport number : AH6155307 Valid until : 09-04-2013 Medical School : Medical University in Lodz Medical student since : 2007 Clinical student since : 2009Expected day of graduation : 30-09-2013 Native language : Polish Other languages : English, German, Swedish, Russian, Medical Latin Street & Number : Inflancka 19/124 City & Postcode : Warszawa 00-189Region & Country : Europe, Poland Phone : 0048226350023 Fax : _____________ Cellular : 0048694528366 Email : zochowskamalgorzata@gmail.com Desired Country : Peru (APEMH)
Desired Cities 1.Cusco-UNSAAC 2. Lima-UCSUR 3. Arequipa Desired Department 1. Surgery-General 2. Emergency Medicine 3. Surgery-Gastrointestinal Surgery 4. Field studied Exam passed Yes Yes Yes No No No

AF number
Info forExchange Officers
Origin NMO Origin LC Hosting NMO Hosting LC IFMSA-Poland (Poland) Lodz, Medical University of Lodz APEMH (Peru) Lima-UCSUR Contract signed Contract Type AF sent on CA sent on11-08-2010 Bilateral 27-02-2011 ---
064298
NEO stamp

Duration : 4 weeks from 01-06-2011 to 30-06-2011 Type of clerkship : Clinical Clerkship Would like to be placed with : Health insurance coverage forthe exchange period : Yes

Invitation Letter needed: Yes

Info for Exchange Officers
Origin NMO Origin LC Hosting NMO Hosting LC IFMSA-Poland (Poland) Lodz, Medical University of Lodz APEMH (Peru)Lima-UCSUR Contract signed Contract Type AF sent on CA sent on 11-08-2010 Bilateral 27-02-2011 ---

Sponsor area

document generated on 11 May 2011

Info for Exchange Officers
Origin NMOOrigin LC Hosting NMO Hosting LC IFMSA-Poland (Poland) Lodz, Medical University of Lodz APEMH (Peru) Lima-UCSUR Contract signed Contract Type AF sent on CA sent on 11-08-2010 Bilateral 27-02-2011 ---

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