University of Health Sciences Antigua

To be completed by accepted students only. Submissions without acceptance will be discarded.

Scholarship List^*

First Name^*

Middle or Additional Names

Last Name^*

Email^*

Phone^*

Address^*

Address 2

Country^*

Which one of the following race/ethnic categories best describe you?^*

List of honors, awards, memberships & volunteer activities in which you have participated and the year of participation

Essay^*

Copy of passport^*

Other Supporting Information