First Name * Last Name * Date of birth * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year1986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028 Email * Address Country - None -AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong S.A.R., ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Address 1 * Address 2 City * State * - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming--Armed Forces (Americas)Armed Forces (Europe, Canada, Middle East, Africa)Armed Forces (Pacific)American SamoaFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPalauPuerto RicoVirgin Islands ZIP code * Contact number * Use your 2 digit country code followed by your number omitting the first zero eg. 3227259424 Nationality * National Society * - Select -Algerian Society of Internal MedicineAlbanian Society of Internal MedicineInternal Medicine Society of Australia and New ZealandAzerbaijan Internal Medicine SocietyArmenian Association of Internal MedicineArgentinian Society of Internal MedicineAustrian Society of Internal MedicineBelgian Society of Internal MedicineCypriot Society of Internal MedicineCzech Society of Internal MedicineDominican Republic Society of Internal MedicineEuropean Federation of Internal MedicineEuropean Journal of Internal MedicineEuropean Journal of Case Reports in Internal MedicineEgyptian Society of Internal MedicineEstonian Society of Internal MedicineFinnish Society of Internal MedicineFrench Society of Internal MedicineGerman Society of Internal MedicineAssociation of Therapists of GeorgiaIcelandic Society of Internal MedicineIsraeli Society of Internal MedicineItalian Society of Internal MedicineThi-Qar Internists Association-IraqItalian Federation of Associations of Hospital InternistsHellenic Society of Internal MedicineLatvian Society of Internal MedicineLebanese Society of Internal MedicineAssociation of Physicians of MaltaMoroccan Society of Internal MedicineMacedonian Association of Internal MedicineMexican College of Internal MedicineNetherlands Society of Internal MedicineNorwegian Society of Internal MedicinePeruvian Society of Internal MedicinePolish Society of Internal MedicinePortuguese Society of Internal MedicineRomanian Society of Internal MedicineRussian Scientific Society of Internal MedicineSerbian Association of Internal MedicineSlovak Society of Internal MedicineSlovenian Society of Internal MedicineSpanish Society of Internal MedicineSwedish Society of Internal MedicineSwiss Society of General Internal MedicineTurkish Society of Internal MedicineTurkish Association of Internists Federation of Royal Colleges of Physicians UKSociety of Acute MedicineCeylon College of PhysiciansAssociation of Internists of Ukraine Current position * Year of residence * 3 4 5 6 Travel/medical insurance detail * Exchange centre requested 1st option * - Select - France – Jean Verdier Hospital Sorbonne Paris Nord University, Prof. Bourgarit France - Université Paris Cité Paris France Cochin hospital , Prof. Mouthon France - Service de Médecine Interne-Immunologie Clinique, CHU Tours. France - Groupe Hospitalier Sud Île-de-France, Melun, Île-de-France, Dr. Belfeki Germany – Medizinische Klinik I, Prof. med. Stefan Frantz, Würzburg Germany - Essen University Hospital Greece – Thessaly University Faculty of Medicine, Department of Internal Medicine Greece - National & Kapodistrian University of Athens, Prof. Halvatsiotis Greece - National & Kapodistrian University of Athens, Laikon Hospital, Prof. Samarkos Greece - Evangelismos General Hospital, Prof. Katsanou Greece - Tzaneio General Hospital of Piraeus Greece - Aristotle University, Papageorgiou Hospital, Prof. Kotsis Greece - Aristotle University, AHEPA University Hospital, Prof. Metallidis Greece - University Hospital of Ioannina, Prof. Rizos Greece - University Hospital of Ioannina, Prof. Barkas Greece - University General Hospital of Alexandroupolis Israel – Sheba Medical Center, Tel-Hashomer, Tel-Aviv University Israel - Yoseftal Medical Center Israel - Galilee Medical Center Italy – CAMPUS BIO MEDICO DI ROMA Italy – AOPG – OSPEDALE SANTA MARIA DELLA MISERICORDIA A PERUGIA Italy – OSPEDALE PAPA GIOVANNI XXIII A BERGAMO Italy – AZIENDA OSPEDALIERA UNIVERSITA' FEDERICO II DI NAPOLI Italy – A.R.N.A.S. CIVICO A PALERMO Italy – UNIVERSITA' DEGLI STUDI DI BOLOGNA Italy – FONDAZIONE POLICLINICO UNIVERSITARIO GEMELLI IRCCS DI ROMA Italy – DIPARTIMENTO MEDICO AUSL BO Italy – IRRCCS FONDAZIONE CA' GRANDA, OSPEDALE MAGGIORE POLICLINICO, MILANO Italy – UNIVERSITA' DEGLI STUDI DEL PIEMONTE ORIENTALE NOVARA Italy – AZIENDA OSPEDALIERA UNIVERSITARIA DI BARI Italy – OSPEDALE RIUNITI DI FOGGIA Malta - Diabetes and Endocrine Centre, Mater Dei Hospital, Malta Portugal – Centro Hospitalar e Universitário do Algarve/Hospital de Portimão Portugal – Hospitais da Universidade de Coimbra Portugal – Hospital Santo António Poland – Department of Gastroenterology and Hepatology, Medical University Center Poland – Department of Internal Medicine and Hypertension, Medical University Poland – Department of Internal Medicine and Transplant Nephrology, Medical University Slovakia – Dpt. Internal Medicine nº1, University Hospital Košice Slovakia – Department of Internal Medicine 5, University Hospital Bratislava Spain – Hospital Costa del Sol Spain – Hospital Regional Universitario de Málaga Spain – Hospital Gregorio Marañón Switzerland – Division of Internal Medicine, University Hospital Basel Turkey – Hacettepe University Faculty of Medicine, Department of Internal Medicine Turkey – Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology Turkey – Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine Turkey – Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Practice and Research Centre, Department of Internal Medicine Important information for applicants to Spanish hospitals: Please note that, in order for Spanish hospitals to host internal medicine residents from other countries, a request must be submitted through the official portal of the Spanish Ministry of Health. For more information, please visit the Spanish Ministry of Health website from - 1st Option * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20242025202620272028 to - 1st Option * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20242025202620272028 Exchange centre requested 2nd option * - Select - France – Jean Verdier Hospital Sorbonne Paris Nord University, Prof. Bourgarit France - Université Paris Cité Paris France Cochin hospital , Prof. Mouthon France - Service de Médecine Interne-Immunologie Clinique, CHU Tours. France - Groupe Hospitalier Sud Île-de-France, Melun, Île-de-France, Dr. Belfeki Germany – Medizinische Klinik I, Prof. med. Stefan Frantz, Würzburg Germany - Essen University Hospital Greece – Thessaly University Faculty of Medicine, Department of Internal Medicine Greece - National & Kapodistrian University of Athens, Prof. Halvatsiotis Greece - National & Kapodistrian University of Athens, Laikon Hospital, Prof. Samarkos Greece - Evangelismos General Hospital, Prof. Katsanou Greece - Tzaneio General Hospital of Piraeus Greece - Aristotle University, Papageorgiou Hospital, Prof. Kotsis Greece - Aristotle University, AHEPA University Hospital, Prof. Metallidis Greece - University Hospital of Ioannina, Prof. Rizos Greece - University Hospital of Ioannina, Prof. Barkas Greece - University General Hospital of Alexandroupolis Israel – Sheba Medical Center, Tel-Hashomer, Tel-Aviv University Israel - Yoseftal Medical Center Israel - Galilee Medical Center Italy – CAMPUS BIO MEDICO DI ROMA Italy – AOPG – OSPEDALE SANTA MARIA DELLA MISERICORDIA A PERUGIA Italy – OSPEDALE PAPA GIOVANNI XXIII A BERGAMO Italy – AZIENDA OSPEDALIERA UNIVERSITA' FEDERICO II DI NAPOLI Italy – A.R.N.A.S. CIVICO A PALERMO Italy – UNIVERSITA' DEGLI STUDI DI BOLOGNA Italy – FONDAZIONE POLICLINICO UNIVERSITARIO GEMELLI IRCCS DI ROMA Italy – DIPARTIMENTO MEDICO AUSL BO Italy – IRRCCS FONDAZIONE CA' GRANDA, OSPEDALE MAGGIORE POLICLINICO, MILANO Italy – UNIVERSITA' DEGLI STUDI DEL PIEMONTE ORIENTALE NOVARA Italy – AZIENDA OSPEDALIERA UNIVERSITARIA DI BARI Italy – OSPEDALE RIUNITI DI FOGGIA Malta - Diabetes and Endocrine Centre, Mater Dei Hospital, Malta Portugal – Centro Hospitalar e Universitário do Algarve/Hospital de Portimão Portugal – Hospitais da Universidade de Coimbra Portugal – Hospital Santo António Poland – Department of Gastroenterology and Hepatology, Medical University Center Poland – Department of Internal Medicine and Hypertension, Medical University Poland – Department of Internal Medicine and Transplant Nephrology, Medical University Slovakia – Dpt. Internal Medicine nº1, University Hospital Košice Slovakia – Department of Internal Medicine 5, University Hospital Bratislava Spain – Hospital Costa del Sol Spain – Hospital Regional Universitario de Málaga Spain – Hospital Gregorio Marañón Switzerland – Division of Internal Medicine, University Hospital Basel Turkey – Hacettepe University Faculty of Medicine, Department of Internal Medicine Turkey – Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology Turkey – Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine Turkey – Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Practice and Research Centre, Department of Internal Medicine Important information for applicants to Spanish hospitals: Please note that, in order for Spanish hospitals to host internal medicine residents from other countries, a request must be submitted through the official portal of the Spanish Ministry of Health. For more information, please visit the Spanish Ministry of Health website from - 2nd option * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20242025202620272028 to - 2nd Option * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20242025202620272028 English level * Intermediate Advanced Proficient Native Accreditation English Please submit your CV * Please submit Statement of purpose for the Exchange Program tutor * Please submit letter of support from your National Society * Leave this field blank CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
