Application

                                       for scholarship USMLE


I would like to apply for a financial contribution regarding the expenses associated
with USMLE (United States Medical Licensing Examination).


Name and surname


UČO


Study programme


Year of study


Permanent address


Contact address



Step of USMLE



Note:  Please as an attachment provide a Certificate of Completion USMLE and a proof of payment of
examination´s costs. Notice, that your account number must be submitted in the Information System
of MU (IS).

Note: Hand in this application to Bc. Zuzana Pilatova from International Studies Office.



.………………………………                                             ………………………………..…   Date
                                                                     Student´s signature





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Dean’s Office responsible person’s signature, stamp






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Vice-dean´s decision