University of Health Sciences Antigua

Personal Information

First Name^*

Last Name^*

Additional Names

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

Apply for Readmission

Personal Information

Mailing Address

Emergency Contact

Program Information

Additional Information

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Apply for Readmission

Personal Information

Mailing Address

Emergency Contact

Program Information

Additional Information

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