Data concerning the application

Type of person *

Students

Teachers

Please fill out this mandatory field.

Type of application *

Incoming

Outgoing

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Exchange Programme *

Please fill out this mandatory field.

Academic Year *

Please fill out this mandatory field.

Stay from *

Always the first monday of the month

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Stay until *

Duration of stay: always 4 weeks

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Personal Data

Last name *

Please fill out this mandatory field.

First Name *

Please fill out this mandatory field.

Gender *

male

female

divers

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Date of birth *

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Nationality *

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Passport number *

The length should be between 1 and 13 characters.

Place of birth *

Please fill out this mandatory field.

Email address *

Please fill out this mandatory field.

Please choose a valid e-mail address.

Verify address

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Your inputs do not match.

Mobile phone number *

The length should be between 1 and 100 characters.

Contact person in case of emergency

Last Name *

Please fill out this mandatory field.

First Name *

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Email address *

The length should be between 1 and 100 characters.

Telephone number *

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Current Study details

Country of Home Institution *

Please fill out this mandatory field.

Home Institution *

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Home Institution (if not listed above)

Study progamme at home institution *

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Year of study *

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Information of the recieving institution

Country of Host Institution

Host Institution

Subjects

Elective subject - Preference 1 *

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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. *

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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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Application for a student exchange

Data concerning the application

Personal Data

Contact person in case of emergency

Current Study details

Information of the recieving institution

Subjects

Confirmation by the student

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