Note: Please print this form and mail to our Consultant: Royal Medical & Technical Consultants Inc, 6212, Monee Manhattan Rd Monee Illinois 60449 with $75 application fee and all the enclosures as listed in check list at end of this form.
Windsor University School of Medicine
P.O. Box 1621, Bird Rock, Basseterre, St. Kitts, West Indies
APPLICATION FOR ADMISSION
Application fee paid:
Official Check/Bank Draft No:
 Date:
Official use only:
 

 

 
 
I WOULD LIKE TO BE CONSIDERED FOR ADMISSIONS BEGINNING:
 
 
 January
 
 May
 
 September
 
 Year Regular / Transfer
 
 
M.B.B.S.
 
M.D.
 
Premed MD
 
PG DIM
Clinicals / Basics
   
Section I-Identifying Information
     
 
(Sur) Last Name:
            
 First Name:
            
Middle Name:
            
 Address:
            
City:
            
 State:
            
Zip Code:
            
 Country:
            
Business Phone:
            
 Home Phone:
            
Social Security No:
            
 Citizenship:
            
Birth Date:
            
 Sex:
 
 
 Male
 
 Female
Visa Status:
            
 E-mail:
            
 
 
MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
     
 
Address:
            
 City:
            
State:
            
 Country:
            
Zip Code:
            
    
 
 
WHO TO NOTIFY IN CASE OF EMERGENCY
     
 
Last Name:
            
 First Name:
            
Middle Name:
            
 Address:
            
City:
            
 State:
            
Zip Code:
            
 Country:
            
Business Phone:
            
 Home Phone:
            
 
 
SECTION II-Educational History(list all schools from High School)
     
 

School Name

Location

Major

Dates Attended

GPA

Graduated
                      
                      
                      
                      
                      
 
     
  Have you attended an American or Foreign medical school previously?  
 

School Name

Location

Dates Attended
     
     
     
 
     
  List all medical schools for which you have applied in the last two years?  
 

School Name

Location

Dates Attended
     
     
     
 
     
  Please List all undergraduate and graduate work completed. A transcript must be received from each institution prior to the application being reviewed  
 

Course

Institution

Dates

Grade
       
       
       
 
 
Scholarships, Distinctions, Academic Achievements and Honors
 

Achievements

Date
   
 
 

Medical College Admissions Test (Optional)
 

Date Taken

Verbal

Phys.Sci

Writing

Biol.Sci
         
         
 

SECTION III-Personal Information
 
Marital Status
  
No. of Dependents
  
Spouse's Name    Age    Occupation   
Father's Name    Age    Occupation   
Mothers Name    Age    Occupation   
Dependent - 1    Age    Relation ship   
Dependent - 2    Age    Relation ship   
 
 
  1. Do you have any physical handicaps?
  2. Are you presently under the care of physician?
  3. Are you presently taking medications prescribed by a physician?
  4. Please describe any medical conditions which may need attention during your enrolment at Windsor?
  5. Have you ever been hospitalized for any physical or mental illness?
  6. Have you had or do you currently have a substance abuse problem?
  7. Have you ever been dismissed from any academic institutions ?
  8. Have you ever been convicted of a felony or crime involving moral turpitude?
  9. How do you plan to pay your education at Windsor?
  • ---------% Federal Loans
  • ------------% Family Support
  • ---------% Private Loans
  • -----------% Personal Savings
  • -------------% Others.
10. How many individuals, whether family members or dependents, will join you while you are studying at Windsor      University?
11. How did you learn of Windsor university School Of Medicine?
12.List all college, community , and other activities which you participated and any elective or honorary positions held :
 

Employer

Title

Function

Date
       
       
       
 
On this field and others if necessary, please explain to the admissions committee why you wish to attend the Windsor University School of Medicine, what assets you bring to the university, why you wish to become a medical doctor and any other aspects you feel would be helpful to Windsor in evaluating your potential: (In separate Sheet)
CHECK LIST:
All applicants must complete the application and submit the following:
  1. Completed Application Form
  2. Application fees of $ 75 by Cashier cheque or Bank draft in favor of 'Royal Medical & Technical Consultants Inc.'
  3. 2 passport size photographs
  4. 2 letters of recommendation.
  5. Official transcript or notarized copy of the transcript.
  6. Personal statement.
  7. Curriculum Vitae
Note: Please Mail all the above Documents directly to
Our Consultant: Royal Medical & Technical Consultants Inc
6212, Monee Manhattan Rd
Monee Illinois 60449