Dr. Nirmala Swami - U M P I R E

  • PROGRAM TYPE*
  • Application Fee Payable to University of Miami:

    An application fee of US$ 75.00 needs to be paid along with the completed application. This is payable to University of Miami .

  • Full Name*
  • Email Address*
  • Phone Number*
    Country Code + City Code + Phone Number
  • Additional Phone Number
    Country Code + City Code + Phone Number
  • Address*
  • The program offers clinical rotations in the following specialties. Please indicate your choice in order of preference. Depending on the availability and opening your admission will be decided.

  • First Option*
  • Second Option*
  • Third Option*
  • Fourth Option*
  • Fifth Option*
  • Sixth Option*
  • Name of the Medical School*
  • University Affiliation*
  • Medical School Address and Phone Number*
  • Date of Start-Medical School*
  • Date of Completion-Medical School*
  • Date of Completion of Internship*
  • Have you met all requirements for MBBS*
  • USMLE*
  • Do you have research experience?*
  • If yes,please provide details
    (Add Seperate Page if Necessary)
  • Are you interested in research*
  • If Yes, What sub-specialty interests you?
  • Please scan & E-mail

    Submit all applicable documents.

  • Documents
  • Amount and Source of Funding US$ 30,000.00

    List the amount of funding if receiving funding from more than one source, indicate the amount received from each source. If using personal or university funds, you must provide original documentation of amounts listed (letters must be on letterhead and must be originals; personal funds may be verified with certified copies of bank statements. Please provide amounts in US Dollars on all documents.

  • Source of Funds*
  • If Other - Describe
  • For Visa Documentation

    Please provide the address and phone number for the location to which your acceptance letter should be sent. Phone numbers are required.

  • Mailing Address*
  • Phone Number*
  • Email Address*
  • Acknowledgment:

    I ACKNOWLEDGE THAT BY SIGNING THIS APPLICATION, I AM AGREEING TO THE TERMS OF ADMISSION INTO UNIVERSITY OF MIAMI FELLOWSHIP PROGRAM AND THAT ALL THE INFORMATION CONTAINED HEREIN AND IN ANY ACCOMPANYING DOCUMENTS IS TRUE AND CORRECT.

  • Signed by:*
    Print name here
  • Today's Date:*
  • Signature*
    Please sign in Blue Ink.
  • Security Code*

     

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