1. All sections of this form must be completed in full.
2. Please TYPE all details except your signature.
3. Correspondence will be by email. Please ensure that your email address is clearly legible.
4. Applications can take up to six weeks to process.
5. Please write to firstname.lastname@example.org for further assistance
Department -list in order of priority
No. of Weeks
Preferred dates from
Preferred dates to
This section must be signed by the applicant.
1. I confirm that I do not have any criminal convictions, other than that may have arisen from road traffic accidents, and that I am not aware of any circumstances that would make me unsuitable for studentship as an Elective Student of the Faculty of Medicine, University of Jaffna, Sri Lanka.
2. I will enter Sri Lanka with Student Visa for my elective attachment(s) at the Faculty of Medicine, University of Jaffna
3. I am aware that a payment of US $55 per week must be paid to the University of Jaffna.
4. I will ensure that the relevant amount is paid in full to the Finance Branch, University of Jaffna or a branch of the People’s Bank, before I commence my elective attachment at the Faculty of Medicine, University of Jaffna.
5. I understand that I will need to produce proof of payment along with the letter of authorization from the Dean to the elective coordinator before I commence my elective attachment at the Faculty of Medicine, University of Jaffna.