University of Health Sciences Antigua

Personal Information

First Name^*

Last Name^*

Additional Names

Passport 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.

Student ID Number

Social Security Number

U.S. citizens and permanent residents

Date of Birth^*

Country of Birth^*

Country of Citizenship^*

Gender^*

Email^*

Primary Telephone^*

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^*

Former students who are transferring medical school credits to UHSA should not complete this application. Instead, please begin the Transfer process by starting a new online application at www.uhsa.ag.

Desired Readmission Start Date^*

Medical school entry dates occur in January, May, and September.
Nursing school entry date only occur in September.

Additional Information

Reason for leaving UHSA:^*

Please explain below

Why are you returning to UHSA?^*

Have you been employed since leaving UHSA?^*

If Yes, please indicate employer

Have you taken courses at another college?^*

If Yes, please provide the school and course names

If Yes, please indicate employer

If you experienced academic difficulties, how has your study process improved?

Are there any special factors that you wish to share with the Committee reviewing your readmission application?^*

Fees

Mandatory Fees
	Readmission	1000.00
	Total	1,000.00

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 for Readmission

Personal Information

Mailing Address

Emergency Contact

Program Information

Additional Information

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