University of Health Sciences Antigua

Personal Information

First Name^*

Middle or Additional Names

Last Name^*

Professional Profile Photo^*

Upload a professional passport-sized photograph of yourself which will be used for your student ID card and your portal profile picture. This can be changed at a later date.

Photo I.D or Passport

Upload a copy of your photo ID or passport photo page

Date of Birth^*

Country of Birth^*

Country of Citizenship^*

Gender^*

Email^*

Primary Telephone^*

How did you hear about UHSA?^*

Mailing Address

Address^*

Address 2

City^*

State/Province^*

ZIP or Postal Code

Country^*

Emergency Contact

Emergency Contact Name^*

Emergency Contact Telephone^*

Relationship^*

Program Information

Application Type^*

Students seeking readmission should not complete this application. Please complete the appropriate application.

If Transfer, why are you transferring medical schools?

If you are a displaced Ukraine medical student, please select your current school

Program of Interest^*

Anticipated Start Date^*

Academic Information

Please enter all institutions attended, beginning with the most recent. If you earned an undergraduate and graduate degree from the same institution, please enter it for each level of study. You can upload a copy of your transcript below.

*Please note: Transcript upload is not required for submitting your application, and you can email documents directly to your admissions representative any time after submitting your application.

Secondary School / High School Name^*

Secondary School / High School Graduation Date^*

Secondary School / High School Transcripts

A copy of your unofficial high school, university, or medical school transcripts can be uploaded while we wait for your official copy. Please note an official copy is required for admission.

Secondary School / High School Diploma

For Premedical Sciences students, a copy of your official high school diploma can be uploaded while we wait for your official copy. Please note an official copy is required for admission.

College / University Name

College / University Entry Date

College / University Graduation Date

College / University Transcripts

A copy of your unofficial university transcripts can be uploaded while we wait for your official copy. Please note an official copy is required for admission.

College / University Name

College / University Entry Date

College / University Transcripts

A copy of your unofficial university transcripts can be uploaded while we wait for your official copy. Please note an official copy is required for admission.

Transfer Students

Medical School Name

Medical School Entry Date

Medical School Transcripts

A copy of your unofficial medical school transcripts can be uploaded while we wait for your official copy. Please note an official copy is required for admission.

Personal Statement

In 400 words or less, provide an example(s) of unique hardships, challenges, or obstacles that have influenced your decision to attend medical school. In your statement, include any significant accomplishments or additional information that would be useful in evaluating the application.

Personal Statement^*

Why have you selected the field of medicine?^*

What motivates you to learn more about medicine?^*

Why have you chosen to apply to UHSA?^*

Why are you considering a career in medicine?^*

Supporting Information

TOEFL Exam Score (if taken)

Pleases upload a copy of your TOEFL Exam Score if available.

MCAT documents (if taken)

Pleases upload a copy of your MCAT Exam Score if available.

If you have previously applied, please the enter the date of your most recent application

Have any of your immediate family members ever attended our institution?^*

If Yes, please provide their names

Have you ever been dismissed/expelled and/or required to withdraw from medical school for any reason?^*

Please explain (if yes)

Academic Honors (Please List)

Extracurricular activities (in-school)

Have you ever been convicted of a criminal offense (felony or misdemeanor)?^*

Please explain (if yes)

How do you plan to pay for your medical education?^*

References

Please note: We recommend using your reference's institutional or corporate email address. Submissions from anonymous email addresses (Gmail, Hotmail, Yahoo) may be subject to additional review.

Full Name (Reference one)^*

It may be changed at a later date.

Email (Reference one)

Telephone (Reference one)

Reference Type (Reference one)^*

Full Name (Reference two)^*

It may be changed at a later date.

Email (Reference two)

Telephone (Reference two)

Reference Type (Reference two)^*

I certify that all of the application's information is my own work, factually true, and honestly presented. My electronic submission of my full name below is equivalent to my signature and is a certification of the accuracy and completeness of the information I have provided. Further, I understand that I may be subject to a range of possible disciplinary actions, including admission revocation or expulsion, should the information I certified be false.

I also understand that as a student, it is my responsibility to understand the licensure requirements of the state or country where I seek to be licensed and that it is not the responsibility of the University of Health Sciences Antigua if those state or country regulations change during my medical education.

I hereby grant permission to the University of Health Sciences Antigua to reproduce any portion of photo images or video that have been taken on-campus, at clinical clerkships, or at any university-sponsored event to be used for the purpose of promotional publications, which can include but is not limited to, books, cards, calendars, invitations, and websites without any more compensation or recognition given to me. Furthermore, I grant creative permission to alter the photograph(s). I do not grant permission to resale or use the photographs in a manner that would exploit or cause malicious representation toward me or my company and associates.

Please accept the terms & conditions to submit this form.

Application for Admission - University of Health Sciences Antigua