Application Form for Incoming Students
Faculty of Health Sciences
2012-2013

Page 1 (of 2)


Personal Data

Given/first name
Family name
Date of birth

Day Month Year

Four last numbers/P-number (if you have studied at LiU before)
Gender
Citizenship

Current address

Valid from (date yy-mm-dd)
Valid to (date yy-mm-dd)
C/O (name on the door if it is different from your own name)
Street and number
Postal code
City
Country
Email
Telephone number (incl country code)
Mobile/cell phone

Alternative address
(always valid - Example: parents' address)

Valid from (date yy-mm-dd)
Valid to (date yy-mm-dd)
C/O (name on the door if it is different from your own name)
Street and number
Postal code
City
Country
Email
Telephone number (incl country code)
Mobile/cell phone

Academic Data

Exchange Programme
Sending university
If your university is not in the list please write the name here
Study programme
Current semester of study
Coordinator/Contact person at sending university
(incl telephone, fax, and e-mail)
 

Period of Study at Linköping University

Which semester are you applying for?

Your study period at LiU - Semester:

Please note:

- Autumn semester 2012 starts on Friday 17 August for exchange studens with a mandatory Orientation Programme, followed by a mandatory Orientation Week, 20-24 August.

- Spring semester 2013 starts on Friday 11 January for exchange studens with a mandatory Orientation Programme, followed by a mandatory Orientation Week, 14-18 January.

From: DayMonth Year

Please note: your starting date will be 17 August (autumn semester) or 11 January (spring semester).

Last day of study: Day Month Year

Swedish language classes For the autumn semester, Swedish lessons will be offered as an intensive beginner's course from 2 August (Erasmus students can apply through their home university to take this as an Erasmus Intensive Language Course). During the spring semester 2013, it will not be possible for Faculty of Health Sciences students to participate in an intensive beginner's course. Evening classes during the semesters will be offered. We will send out more information about how to enrol for these courses after 15 April/15 October.


Preliminary study plans at Linköping University (Learning Agreement)

Please state, in order of preference, which clinical placements/courses you want to apply for within your study programme.


MEDICINE

Theoretical modules:
1st module

2nd module (not compulsory)
3rd module (not compulsory)

 

Clinical modules

 

Number of weeks

1st choice
2nd choice
3rd choice
4th choice
5th choice

 


MEDICAL BIOLOGY

1st choice
2nd choice
3rd choice
4th choice
4th choice
5th choice
Project description
Print name and email address of academic coordinator at your home university

NURSING

 

 

Number of weeks

1st choice
2nd choice
3rd choice
4th choice
5th choice
Print name and email address of academic coordinator at your home university

OCCUPATIONAL THERAPY

 

Number of weeks

1st choice
2nd choice
3rd choice
4th choice (if the first three are not possible)
5th choice (if the first three are not possible)
Print name and email address of academic coordinator at your home university

PHYSIOTHERAPY

Clinical modules:

Number of weeks

1st choice
2nd choice
3rd choice
4th choice
5th choice

Theoretical modules:

1st choice (not compulsory)
2nd choice (not compulsory)
Print name and email address of academic coordinator at your home university

SPEECH AND LANGUAGE PATHOLOGY

Course
Course
Course
Print name and email address of academic coordinator at your home university

Accommodation

If you wish to apply for student accommodation, select below:

Yes, I need student accommodation

No, I do not need student accommodation

From: Month Year

LiU has a limited number of rooms for exchange tudents. Therefore, we advise you to register and apply for a room with Studentbostader, www.studentbostader.se as soon as possible.


Contact information in case of emergency

This information will be used by Linköping University in case an emergency situation takes place once you are in Linköping. List the name, address, and telephone number of at least one person that we may contact in case of an emergency.

Relation (mother, father, etc)
Full name
Address
Telephone number (incl country code)
Mobile/cell phone (incl country code)

 

Please check the information carefully before clicking on "Submit" to continue! Do not print this page. Please wait until your application is recorded and print the next page. Follow the instructions on the print-out.


Responsible for application form: Anna Sandelin