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Order Form

With this online form, you can directly hire MediStart to place you in a course of study in your chosen subject.

In order to hire us via the online form, you must be at least 18 years old. If you are under the age of majority, please click here.

Please fill in all fields marked with *.

And it’s that simple:
  1. Fill in the form and send it back.
  2. Processing by MediStart and information on the next steps, admission procedures etc.
  3. Coaching by MediStart, test participation etc.
  4. MediStart will find you a place to study.
  5. On-site MediStart support abroad.
Selected university*:
Second choice*:
Selected field of study*: Medicine  
Dentistry  
Veterinary medicine
Start of studies*: Winter semester 2021/22   Summer semester 2022 (Riga only)
Passport photo:
(possible formats: .jpg, .png)
First name*:
Last name*:
Street*:
Number*:
Postcode*:
Town*:
Country*:
Other country:
Date of birth*:
For underage applicants, placing an order is only possible in writing. For information sheets with our order form please click here.
Place of birth:
Citizenship*:
Gender*: male   female
Telephone (landline)*:
Telephone (mobile):
Email*:
Link to Facebook profile:
Additional information (e.g. internships, training, social/church involvement etc.):
Year of graduation (Secondary school)*:
Type of diploma*: High school diploma   IB   A-Level
Others:
Grade average*:
Name of last school*:
Attended from*:
Attended until*:
The final grades…

…in junior high (8th/9th grade):

School subjectGradeGrade
Biology
Chemistry
Physics
Mathematics
…at orientation level (10th/11th grade):

School subjectGradeGrade
Biology
Chemistry
Physics
Mathematics
…at orientation level (12th/13th grade):

School subjectGradeGrade
Biology*
Chemistry*
Physics*
Mathematics*
English*
…in your final examination:

School subjectGrade 
Biology*
Chemistry*
Physics*
Mathematics*
English*
Yes, I ensure the data provided above is complete and correct (please select).
Yes, I am aware that there is a charge for placement and study abroad (please select).
Yes, I have read the „Price Information„, the „General Terms and Conditions“ and the „Information on the collection, processing and use of the data provided by me“ and I agree to the terms (please select).
Yes, I have taken note of the information on the right of withdrawal (please select).
Yes, I agree and expressly demand that MediStart begins to perform the commissioned service before the end of the revocation period. I am aware that I will lose my right of revocation if MediStart fulfils the contract in full (please select).
   

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