CLINICAL /COMMUNITY ELECTIVE PROGRAMME FOR NURSING STUDENTS
ORGANIZED BY National Centre on Health Professions Education (NCHPE) TU INSTITUTE OF MEDICINE, NEPAL
Application Form
 
Family Name

First Name
Nationality
 Passport Number
Gender: Male Female Date of Birth
Mailing Address of Student
Street Address
City
Zip Code
 Country
Medical Schools Address (in detail)
Medical student since
 Clinical student since
Expected date of graduation:
/
Language Spoken
  
Native Language
 Other Language
Preferred speciality in the department in priority order

Duration (in week)
[weeks]
within the period from (date)
 to (date)
I have health insurance coverage for this period Yes No
Desire type of Clerkship

Pre-clinical Clerkship

Clinical Clerkship

Others
 
 
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