Faculty of Medicine: Students

Instructions

It is better to use Mozilla Firefox or Google Chrome browser to access the form.
Please attach scanned copies of your personal image, recommendation Letter given by Institute and bio-data page of your passport.
Please do not apply twice using a different email address and fake passport numbers. If you have a problem regarding your registration or for any modification. Please contact through elective@med.ruh.ac.lk

ELECTIVE APPOINMENT DETAILS -("Commencing Date" should be Monday of the week of Srilanka Calendar)
Instructions to select the Subjects, Commencing Date and No of Weeks.

First, select the Subject.

Then add the Commencing Date (YYYY-MM-DD).

After that, You should select the No of Weeks from the list.

Then, If you interested add another Subject.

Subjects:

Subject Commencing Date No of Weeks

Add Subject

Total No of Weeks:

PERSONAL DETAILS

Title:

Name:(NAME AS APPEARS IN THE PASSPORT )

Date of Birth:

Pick Date

Home Address:

Telephone:

Fax:

Email:

Upload Personal Image:
(jpg format/Max size 1MB)(The image should be compatible to use for the preparation of an identification card.)

ABOUT YOUR INSTITUTION

Name of the Medical School:

Address:

Telephone:

Fax:

Email:

Date of Joining:

Pick Date

Current Year:

Final Exam Date:

Pick Date

Upload Scaned copy of Recomendation Letter given by Institute:
(pdf format/Max size 1MB)

Emergency Case Contact Details

Name of the Person:

Address:

Telephone:

Fax:

Email:

International Passport Details

Pasport Number:

Country:
Please select your country and relevent visa office from the drop down list.

YES- (IF your country is present in the above list Please select YES)
NO- (IF not Please select NO and enter it in bellow manually.)

Country:

Date of Issue:

Pick Date

Date of Expire:

Date of Arrival to Sri Lanka:

Pick Date

Upload a Scanned copy of the Bio-Data page of your current passport:
(jpg format/Max size 1MB)

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Application Form Elective Students