University of Health Sciences Antigua SIS and LMS Portal.

Personal Information

First Name^*

Last Name^*

Additional Names

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.

Social Security Number

U.S. citizens and permanent residents

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/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.

Program of Interest^*

Anticipated Start Date^*

Academic Information

High School Name^*

High School Entry Date^*

High School Graduation Date^*

High School Diploma

For Premedical Sciences and Nursing 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.

University Name

University Entry Date

University Graduation Date

University or Medical School Name

University or Medical School Entry Date

Supporting Information

Unofficial Academic 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.

Personal Statement (400 Word Minimum)^*

Your personal statement is your opportunity to describe who you are and why you are uniquely qualified for a career in the health professions beyond class performance and standardized test results. Advocate for yourself.

TOEFL Exam Score

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

MCAT documents (if any)

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)

References

Full Name (Reference one)

Email (Reference one)

Telephone (Reference one)

Reference Type (Reference one)

Full Name (Reference two)

Email (Reference two)

Telephone (Reference two)

Reference Type (Reference two)

Fees

Mandatory Fees
	Application	75.00
	Total	75.00

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 UHSA if those state or country regulations change during my medical education.

Please accept the terms & conditions to submit this form.

Apply to UHSA