Medical School Application Form
A medical school application form has to be duly completed and submitted by those students who are applying for a pre-med or medical course in medical schools or universities. Students applying to any medical college in the US have to fill up the AMCAS (American Medical College Application Service) form or can fill college specific basic medical school application form.
You can Download the Free Medical School Application form, customize it according to your needs and Print. Medical School Application Form is either in MS Word, Excel or in PDF.
Sample Medical School Application Form
Medical School Application Form
Download Medical School Application Form
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Medical School Application Form |
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| Name of the Student | Date of Birth | |||
| Address | Home Phone | |||
| Business Phone | ||||
| Personal information of the student | ||||
| Gender | Age | |||
| Religion | Marital Status | |||
| Father’s Name | Mother’s Name | |||
| Address for Correspondence (if different from above) | ||||
| Address | City/State | |||
| Zip | Phone | |||
| Student Information | ||||
| Have you applied for permanent residency? Yes | No | ||||
| Are you an American Citizen? Yes | No | ||||
| Please mention your citizenship | ||||
| Are you an International Transfer Student Yes | No | ||||
| Have you applied to the ABC University of Medical Sciences before? Yes | No | ||||
| If applied before, what course did you opt for? | ||||
| Medical Courses | ||||
| Please check to select the medical courses you want to pursue | ||||
| 1 | Preclinical Courses Year I | 8 | Anesthesia | |
| 2 | Preclinical Courses Year II | 9 | Behavioral Science and Medicine | |
| 3 | Health, Science, & Technology (HST) Courses | 10 | Cardiology | |
| 4 | Courses Meeting the Social Medicine Requirement | 11 | Critical Care and Trauma | |
| 5 | Core Clinical Clerkships | 12 | Dental | |
| 6 | Elective Courses (Clinical and Non-Clinical Courses) | 13 | Endocrinology | |
| 7 | Emergency Medicine | 14 | Gastroenterology | |
| Academic Qualifications | ||||
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Type of course / school/ college | Result | ||
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1 |
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2 |
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3 |
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| Documentations | ||||
| Please attach the following documentation when submitting the application form | ||||
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1 |
Copy of personal details page of the passport | |||
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2 |
Original mark sheet of completion of courses mentioned in the form | |||
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3 |
Original certified copy of degree certificate | |||
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4 |
Copy of medical thesis written by you | |||
| Declaration | ||||
| I understand that the ABC University of Medical Sciences can cancel my application if they find the information provided in the application to be false, incomplete or incorrect. I also understand that any or all documents submitted to the ABC University of Medical Sciences is their property and will not be returned. | ||||
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…………………………………………….. Signature Date |
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Category: Medical Forms
