Select your country*:

Name and address of faculty:

Any already established exchange programs at the faculty?

Contact details of the ‘visit coordinator’ – student:

Contact details of the ‘visit coordinator’ – staff:

Number of possible days of visit:

Number of students allowed to come at one time:

System of learning: PBL, lecture based:

Number of students in faculty:

Number of years of study:

Type of accommodation likely to be available and approximate cost (euro):

Approximate cost per day (food, transportation, etc in euro):

Possibility for pre-clinical visit:

Yes No

Possibility for clinical visit:

Yes No