University of Health Sciences Antigua

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.

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/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 transfer student, please indicate why you are transferring medical schools.

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^*

Please use this section to provide us with a personal statement. In your personal statement, please be sure to include responses to the following questions:

- Why have you chosen to apply to UHSA?
- Why are you considering a career in medicine?
- What do you expect to be your biggest challenge during your medical education, and how do you plan to overcome it?

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 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.

Apply to UHSA