APPLICATION FORM – UNIVERSITY OF PÉCS MEDICAL SCHOOL

Online reg.n: 8107

Registration timestamp: 2022-05-12 23:46:16

for office use only

Stick your passport-size photo here!

stamp and signature of representative

Application deadline: June 30, 2022

Send your signed and scanned application form and required documents as attachments in pdf format to
studentservice.center@aok.pte.hu or to your representative. After admission, submit your application file to
the local representative in your country or directly to the University of Pécs Medical School, English
Admissions and Student Service Office, Szigeti út 12, H-7624 Pécs, Hungary

Representative: 2TM, svetovanje za izobraževanje, d.o.o. (Russia, Ukraine, Belarus, Kazakhstan,

Uzbekistan, Kirgizistan, Moldova, etc.)
I apply for Dentistry

PERSONAL DATA: (please fill as in your passport)

First name (given name): Anis Surname (family name): Zahzah
First name at birth: Anis Surname at birth: Zahzah
Sex (male/female): male Marital status (single/married): single
Date of birth (day/month/year): 20/06/1996
Place of birth (country): Algeria city: Ain mlila - Oumelbouagui
Citizenship: Algerian Mother tongue: Arabic
Other languages:
English: Speaking Reading Writing
Hungarian: Speaking Reading Writing
Other: French - russian Speaking Reading Writing
Planned entrance exam: (location) Hannover - germany (date) May 14, 2022

DATA OF PASSPORT:
Passport number: 169182341 Expiry date: 06/09/2022
CONTACT DETAILS:
Email address: Aniszahzah.z96@gmail.com
Skype live ID or Skype email address: Aniszahzah.z96@gmail.com
Zoom email address: Aniszahzah.z96@gmail.com
Permanent address: 8 Weidenbruch 64 Hannover 30159 Germany
(number / street / city or town / postal code / country)
ICE – person to notify in case of emergency (name & phone number): Youssef Douaissia +49 175 8013185

DATA OF PARENTS:
Mother’s maiden first name: Hadjira Mother’s maiden family name: Benfifi Occupation: Retired
Father’s full name: Zahzah Messaoud Occupation: Retired
Family relations living in Hungary, degree of relation:
ACADEMIC RECORD: (please list schools in chronological order)

Secondary/High school
Name of school Mohamed Zine
Location of school (city or town) Batna

Location of school (country) Algeria

Attended from-to 2013-2022
Number of years attended 4
Registration number of degree/certificate 35005461

Type of degree/certificate Bachelor

Last year’s grade in – Biology: 13/20 Physics: 11/20
Chemistry: 11/20 English: 14/20
I already have a high school leaving certificate
Registration number of degree/certificate 35005461

College/University *
Name of school Odessa national medical university
Attended from-to 2017-2022
Number of years attended 4
Registration number of NA
degree/certificate/transcript
Type of (prospective) degree/certificate ECFMG
(BSc, MSc, MD, etc.)

Premedical Course
Name of school Please choose...
Attended from-to 2022-2022
Number of years attended 0
Registration number of degree/certificate

Type of degree/certificate

I declare that I have never been a student of the University of Pécs, I do not have a Neptun code.

SCHOLARSHIP INFORMATION:
Stipendium registration number: 8106
Diaspora registration number:
SCYP registration number:

FEEDBACK:
Where and how did you first learn about this program? Please specify: Internet
Where else did you get information from: admissions.medschool.pte.hu
DATA MANAGEMENT AND DECLARATION OF APPROVAL
I agree that in the event of an accident, the University of Pécs shall inform the following person so that the
person I indicate can contact me as quickly as possible.
Name Youssef
Phone number +49 175 8013185
Email address Aniszahzah05@yahoo.com

I declare that, in the event of an accident or illness, if I am incapable to act in academic issues, the person
named below shall be entitled to make a statement in my stead so that I will not be disadvantaged due to failure
of time-bound study statements.
Name Youssef
Phone number +49 175 8013185
Email address Aniszahzah05@yahoo.com

I have been informed that all the above mentioned statements will be valid until withdrawal.

I hereby certify that the information I have provided is complete and accurate, and any other supporting
materials, documents are factually true and honestly presented. I acknowledge that these documents are
verified true copies of the original documents and they will become the property of the institution I am
applying to, and they will not be returned to me. I will notify the University of Pécs should there be any
changes to the information provided in this application. I declare that I am aware of the English Program
requirements and conditions of admission valid and published at the official admissions website of the
University of Pécs Medical School (admissions.medschool.pte.hu) at the time of submitting my online
application and fully accept the given conditions. Hereby I allow the University of Pécs to process the data
and documents I supply during my admission procedure, and accept that my data and documents will only
be used for the admission decision and in connection with my studies, according to the data protection
regulations of the European Union and of the University of Pécs.

______________________________ ________________________________
Date signature of the applicant
 CHECKLIST

Name of the Applicant: Zahzah, Anis

Online registration number: 8107
Program applied for: Dentistry
Nationality: Algerian
Place of birth: Ain mlila - Oumelbouagui
Date of birth: 20/06/1996
Passport number: 169182341
Permanent address: 8 Weidenbruch 64 Hannover 30159 Germany
Documents to be scanned and emailed first, then to be mailed in case of admission:
application form (signed by you/your representative) and a passport photo
high school diploma and official transcript of grades*
copy of valid passport
Europass CV
payment receipts of the application/exam fee
transcript of higher courses* (If applying for exemption from the entrance exam).
BSc / BA / MSc / MA degree* (If applying for exemption from the entrance exam).
B2 level English language exam (If applying for exemption from the entrance exam).
medical certificate*
chest X-ray* (doctor’s note, not the image, not older than 1 year)
vaccination card (showing that you are immunized against Hep B and C) OR serology results for Hep B and
C*
HIV test result* (not older than 3 months)
*documents to be submitted in English/officially attested English translation
Please do not send unofficial copies or photocopies of transcripts, diplomas or language examination
certificates. Do send official copies or officially attested English translations of transcripts, diplomas or
certificates. Remember to sign your application form at the end!