Application

$145.00

Surname of Candidate *
First Name of Candidate *
Email Address *
Date of Birth *
Gender *
SSN
Country of Birth *
Permanent Mailing Address *
US Visa Status (if applicable)
Course *
Period for which you are applying *
Application Year *
Are you a first year applicant? *
Preferred country for clinical rotation *
Please list previous school(s) and degree(s) earned as well as years of enrollment and completion
MCAT Scores
TOEFL Scores
Current Citizenship *
Country Originating Passport *
Passport Number *
Marital Status *
Dependents *
Spouse's Name
Spouse's Occupation
Emergency Contact Name *
Emergency Contact Address *
Emergency Contact Phone Number *
Work Experience
Personal History
Please list extracurricular activities in which you participated, leadership, or technical experience gained while in college or outside of college
Clinical History
Please list clinical experience achieved in hospitals, clinics, or other professional practices
Personal Information
Do you have any physical disabilities the school would need to be aware of in order to accommodate you? If so, please describe
Are you presently under the supervision of a physician? If so, please describe
Have you ever been convicted of a crime? If so, please describe
Personal Goals
In the space provided, describe why you want to become a physician and what your goals will be as a physician.
How did you learn of American International School of Medicine? *
I certify that the information submitted in these application materials is complete and accurate to the best of my knowledge. *

Category: Application