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Application for a student exchangeLogo university
All fields marked with (*) must be completed.
Data concerning the application
Type of person
 *
Type of application
 *
Exchange Programme *
Academic Year *
Stay from *
Always the first monday of the month
Stay until *
Duration of stay: always 4 weeks
Personal Data
Last name *
First Name *
Gender
 *
Date of birth *
Nationality *
Place of birth *
Email address *
Verify address *
Passport number *
Mobile phone number *
Contact person in case of emergency
Last Name *
First Name *
Email address *
Telephone number *
Current Study details
Country of Home Institution *
Home Institution *
Home Institution (if not listed above)
Study progamme at home institution *
Year of study *
Information of the recieving institution
Country of Host Institution
Host Institution
Subjects
Elective subject - Preference 1 *
Elective subject - Preference 2
Elective subject - Preference 3
Confirmation by the student
I hereby confirm that all information on the application form is correct and complete.  *
I agree that all personal data submitted during the application process will be automatically stored, processed and used by the Medical University of Innsbruck for the purposes of program administration and evaluation. You can withdraw your consent at any time.  *
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