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All Saints University
                       ONLINE APPLICATION FORM
Incomplete Forms will not be processed.
PERSONAL INFORMATION

NATIONAL IDENTIFICATION NUMBER

US Social Security No.   Canadian Social Insurance No.  Other SIN
CHECK ONE: MALE     FEMALE
FIRST NAME:
MIDDLE:
LAST:
DATE OF BIRTH: (day/month/year) / /
MARITAL STATUS:
EMAIL ADDRESS:
 

HOME TEL. #:             

ALTERNATE TEL. #: 


Are You Can/US Citizen or Permanent Resident?
If non-Canadian and non-US Citizen:
Visa Status: Citizenship Country:

 
MAILING ADDRESS:  
APT/HOUSE# & STREET ADDRESS:
CITY:
PROVINCE/STATE:
POSTAL/ZIP:
COUNTRY:
 
ACADEMIC HISTORY
LIST ALL UNIVERSITIES ATTENDED – INCLUDING CURRENT STUDIES. FOR HIGHSCHOOL STUDENTS, STATE THE NAME OF THE HIGHSCHOOL, ALONG WITH THE EXPECTED DATE OF GRADUATION.

DATE NAME OF INSTITUTION PROGRAM LENGTH OFFICIAL NAME OF DIPLOMA/DEGREE CITY COUNTRY
FROM TO

Check here if you completed the GED instead of graduating from high school. Indicate all high schools attended in the space provided above. Have your official GED scores as well as transcripts from last high school sent directly to us.

Are you currently enrolled in a College/University**? Yes No
If yes, please complete: Name of College/University and in which Country:

*NOTE: An official transcript must be sent from each college attended, including summer credits. Failure to list all  schools, colleges and universities may make you ineligible for admission. A decision cannot be made until all transcripts have been received. Begin with most recent institution attended, and be sure to complete all requested information. Attach a separate sheet if necessary.
 
ADMISSION INFORMATION


Intended Admission Program**:

PROPOSED TERM OF ENROLLMENT:

JANUARY    MAY     SEPTEMBER

ADMISSION CATEGORY:
     FRESHMAN       TRANSFER         RE-ADMIT
 
OTHER INFORMATION

HAVE YOU EVER BEEN WITHDRAWN FROM AN INSTITUTION?        YES           NO

IF YES, WHY? 

HAVE YOU EVER BEEN ARRESTED OR CONVICTED?                  YES           NO

IF YES, WHY?

HAVE YOU EVER BEEN TREATED FOR SUBSTANCE ABUSE?                  YES           NO

IF YES, WHY?

 *****Please Complete Your Personal Statement. You may mail it separately if you wish (Minimum 1 page, maximum 2 pages). Create a rounded portrayal of yourself, and state why it is that you want to become a doctor. Describe any special achievements or talents that you possess, any personal experiences, responsibilities and/or challenges that have impacted you or your academic achievements.*****

ACKNOWLEDGEMENTS:
From whom or where did you hear about ASUSM:
How do you plan to finance your education? (list values in % of total cost)
Personal Savings: %  
Federal Govt. Loans (Currently Unavailable): %
Family/Parental Support: %
Private Loans: % 
Other Sources: % 
If Other Sources please explain: 
 
SIGNATURE: 
DATE SIGNED (dd/mm/yy):
By signing this form you confirm that all information provided is correct and true and complete to the best of your knowledge.