Passport Information or place N/A if not applicable.
Current Mailing Address
Permanent Mailing Address
Please enter previous school(s), dates, and degrees.
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
Please mail an official copy of all documents attached in this section to:
American International School of Medicine
Fax to 413 674 7301
1755 East Park Place Blvd. # 203
Stone Mountain, GA 30087