American International School of Medicine

1755 East Park Place Blvd, Stone Mountain GA 30087

AISM Application for Admission

Personal Data


Passport Information or place N/A if not applicable.


Current Mailing Address


Permanent Mailing Address

Family Information


Emergency Contact

Academic History

Please enter previous school(s), dates, and degrees.


Please attach copies of your MCAT and TOEFL scores (only if TOEFL will apply) to your application form if possible.

Personal History

Please list extracurricular activities in which you participated, leadership, or technical and/or upload a document with the this information below

Please list clinical experience achieved in hospitals, clinics, or other professional practices and/or upload a file with this information below

In the space provided, describe why you want to become a physician and what your goals will be as a physician or upload a document with this information below

or upload a document with this information below

a yes answer does not affect your acceptance

Application Checklist

Please mail an official copy of all documents attached in this section to:
Admissions committee
American International School of Medicine
Fax to 413 674 7301
1755 East Park Place Blvd. # 203
Stone Mountain, GA 30087