Home > Application Form 


Personal Details


Title: *
Last Name: *
First Name: *

Middle Name:

Gender: Female Male
Date of Birth: Day : * Month : * Year : *
Marital Status: Single Married
Country of Citizenship/Nationality: *

If OTHER, Please Specify:

Do you hold dual Citizenship? Yes No

If YES, Pleas Specify:

Telephone Number: *

Contact Information

Email Address: *
Correspondence Address: *
City: *

State/Province:

*

Postcode:

Level of Interest (Degree Programs)


Level of Interest : Doctor of Medicine (M.D.)
Doctor of Dental Medicine (D.M.D.)
Doctor of Pharmacy (Pharm.D.)
If OTHER, Please Specify:

Supporting Documents


Photograph :
Copy of Passport :
Curriculum Vitae (C.V.) / Résumé :
Cover Letter / Motivation Letter :
Academic Degree 1 (High School Leaving
Certificate or 12th grade Certificate) :
Transcript of the Records / Mark sheets 1 (12th grade Transcripts) :

Academic Degree 2 :

Transcript of the Records 2 :

Recommendation Letter 1 :

Recommendation Letter 2 :

English Proficiency Certificate :

Please Upload Your Sponsorship Letter (if you have one) :

Are you applying through an HUMS Official Agent? :

Yes No

If YES, Please type the Name or the Code of the agent :

How did you hear about us? :