ARAB REPUBLIC OF EGYPT

MINISTRY OF HIGHER EDUCATION

Recent                               FOREIGN STUDENTS WELLFARE DEPT.

Photo                                    2, DAREEH SAAD ST.,

INFORMATION ABOUT EXCHANGE SCHOLARSHIP CANDIDATE

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Full Name(In Block letters, underlining the surname)

Address in Homeland

Date and Place of birth

Nationality of Candidate

Social State : Single or Married

Religion

Scientific Degree, date of graduation

Previous scholarships obtained

Date and Country granting

Proposed study in A.R.E.

Do you want to obtain a degree in A.R.E.?

State the Degree

Or,

Do you want to study as a listener?

Your master of language(Arabic, French)

Proposed date of commencement of scholarship and duration

Passport No.

Date and place of Issue

Date

Signature of Candidate

Medical Certificate

▪Full Name:

▪Sex: □Male	□Female	Photo

▪Date of Birth:

▪Nationality: Republic of Korea

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1. Physical Examination:

Height: ____________ cm        Weight :              kg

Blood Pressure: Systolic              Diastolic              mmHg

Body Build: Slender (     )   Medium (      )  Heavy (      ) Obese (       )

Vision: Right 20/             Left 20/              Color Vision

Corrected: Right              /15  Left              /15

Dental Evaluation: Good (    )  Fair (    )  Poor (    ) Needs Attention (     )

Clinical Evaluation:

	Normal	Abnormal		Normal	Abnormal
Skin			Heart
Head & Face			Abdomen
Eyes			Rectum
Ears			Genitalia
Mouth & Throat			Extremities
Nose & Sinuses			Back & Spine
Neck			Neurological
Chest & Lungs			Mental
			Other

If Abnormal:

2. Chest X-ray Examination

Date Taken:

Findings:

3. Laboratory Examination

Hemoglobin:             Gm/  dl

Urine: S.G.              Albumin              Sugar             Micro.

Stool for Parasite Oval:

Serological Test for Syphilis & AIDS :

Hepatitis :

Other:

4. Summary:

This is to certify that the above named applicant has gone through a general medical examination and the findings indicated here are true to the best of my knowledge.

In my opinion his/her health condition is

Excellent (   )  Good (    )  Fair (    )  Poor (    )

Remarks:

Date	. .
M.D.
Signature

Hospital or Institute

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