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,LLC (ADA)

Study Medicine Abroad


Int’l Consultants & Placement Specialists, USA
Web: www.AmericanDreamAbroad.com Ph: 248-419-0284
Email: info@AmericanDreamAbroad.com or EasyMedSchool@yahoo.com 209-832-3111

Application for Admission into


2” X 2”
University Medical School
(For International Students- in English) Picture

Here

>>>>>>><<<<<<<

Name: First _____________________ Middle: ___________ Last: ___________________

Father: Mr. _ ___ Mother: Ms.________________________

Profession: Profession:

Applying for Mar / Sept 200 . Date of Birth: _____________________

Citizen of: _____________Perm Resident / Visa ________ Place of Birth______________

Passport No: _______________________________ Exp Date: _______________


(We need this for your authorized Govt visa document. Write the passport # even if it has expired. Renew it now for your visa and travel.)

SSN ______ - _____ - _________ Marital Status: Single / Married/ Divorced

Current Mailing Address*:____________________________________________________

_________________________________ Zip _______________ Country_____________

Applicant’s Cell*: (_____) _________________ Home*:(_____)_____________________

Work*: (_____) ______________________ Fax*: (_____) ______________________

Applicant’s email address*: ___________________________________

Permanent Address*: _____________________________________Zip ________Country_______

Housing required at the School (when available): Yes / No


(Please leave no blanks. If not applicable write NA. Circle the answers where applicable.) Page 1 of 4
LLC (ADA)
Study Medicine Abroad
Int’l Consultants & Placement Specialists, USA
Web: www.AmericanDreamAbroad.com Ph: 248-419-0284
Email: info@AmericanDreamAbroad.com or EasyMedSchool@yahoo.com 209-832-3111

Name: First:_______________ Middle: ________________Last: _____________________

1. Present School (if any), City & State: _____________________________________________________, ____________

Studying now (BS/ MS/ PhD, DDS etc) _______________ Year 1 2 3 4 5 (circle)

2. Highest Degree_________________ Dates of Attendance From: ______________ Until: ____________________

Grad. Date: ___________________ Univ/ College: ________________________ City, State: _______________

3. High School Name ___________________________________________________ City, State: _________________

Country_______________ Grad. Date: ___________________ Dates: From: ____________ Until: _____________

4. Present occupation: _________________ Address______________________________________, Ph: _____________


(if you are working)

Current Academic Status:


(Courses completed any time in College or High School (HS): Please circle Yes or No)

English I: Yes / No ( College/ HS ) English II: Yes / No ( College/ HS )

Biology I: Yes / No ( College/ HS ) Biology II: Yes / No ( College/ HS )

Chemistry I: Yes / No ( College/ HS ) Chemistry II: Yes / No ( College/ HS )

Physics I: Yes / No ( College/ HS ) Physics II: Yes / No ( College/ HS )

Organic Chem: Yes / No ( College/ HS ) Other medical related courses, if any:

GPA in: College___________________ Pre Med: _____________ High School: ________________

SAT/ ACT scores:

MCAT: Yes / No: Score: Biology:__________ Physics: __________ Verbal: _________ Writing: __________
(not essential)

Criminal History: Yes / No Academic suspension: Yes / No

Took illicit drugs any time Yes / No Have you been arrested by police any time: Yes / No

If YES to any of the above, please explain: ___________________________________________________________

(Attach separate sheet if necessary)

LLC (ADA)
Study Medicine Abroad
Int’l Consultants & Placement Specialists, USA
Web: www.AmericanDreamAbroad.com Ph: 248-419-0284
Email: info@AmericanDreamAbroad.com or EasyMedSchool@yahoo.com 209-832-3111

Name: First:_____________ Middle: _____________ Last: _______________________

Tell us about you: (Why you want to become a Doctor? Motive– your plans- in 10 years- in a few words)

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Research Experience: ___________________________________________________________


(If any-not essential)

Voluntary Experience & Hobbies: __________________________________________________

(if any-not essential) _________________________________________________________________________________________

Personal Health History*:__________________________________________________________

______________________________________________________________________________

Present Medications: _____________________________________________________________

Allergies* (Meds, Pollen)_____________________________

Psych History, if any (Depression/ Mania)____________________________________________________________________

Name of Spouse: __________________________ Her/ His Occupation:_______________

Emergency Contact for easy reach: Name: Ms/ Mr______________________________

Relation & Profession: _________, ____________________

Emergency Phone Numbers: Cell: (_____) _________________

Home: (_____) _____________________ Work: (_____)______________________

Address: ___________________________________________________ Zip: _________

Page 3 of 4
,LLC (ADA)
Study Medicine Abroad
Int’l Consultants & Placement Specialists, USA
Web: www.AmericanDreamAbroad.com Ph: 248-419-0284
Email: info@AmericanDreamAbroad.com or EasyMedSchool@yahoo.com 209-832-3111

Name: First: _________________ Middle: ___________ Last: ______________________

Applicant’s Declaration

I certify that the information and answers given by me in my application to American Dream Abroad, LLC (ADA), and in this admission process are
accurate and complete to the best of my knowledge and belief. I am aware that the Admissions Committee of ADA, the placement firm, in the first
step screens, verifies and evaluates my application and decides to select me and will let me know. In the next step matches me with the best
possible school and facilitates my admission into the medical school on payment of the admission fee. I know ADA has agreements with many
medical schools/colleges/universities abroad. The worldly – international or national, governmental or non-governmental bodies like the medical
councils, commissions or organizations etc themselves decide/ vary the recognition of the universities, medical schools/colleges and their degrees
at their own discretion. I am aware the medical school decides the rules, regulations, facilities, fees, curriculum, the duration of the courses,
policies etc all the time and they may vary from one school to another. I shall abide by the policies, rules and regulations of the medical school/
college/ university and ADA and their rules or conditions may vary at any time without notice and I know that all fees are nonrefundable. I know
that ADA’s role is limited to facilitating my admission into one of the medical schools/ colleges/ universities. I declare that I have no physical and
psychological disabilities, which come in way of my stay, study and/or behavior at the medical school.

I request ADA to find me a place and facilitate my admission into a meritorious medical school/ university, which had been teaching in English for
long time. If I get selected and admitted in medical school, I am aware that ADA is in no way liable for any occurrences or events, which I may
experience anywhere at any time, before, while or after attending and also while traveling to/ from the university Medical school. I further agree
that jurisdiction for any or all actions against the affiliate university, medical school, ADA, their owners, members, staff, officers or associates lies
solely within the city of the affiliate school/ university’s physical location, and that all actions will be remanded to arbitration within that city and I
further agree to bear all the costs of litigation any time if any need arises at all.
I appreciate and thank ADA for making me aware of this beautiful opportunity of medical school admission thru its extensive and expensive
advertisements in different media like News papers, TV, Radio etc and also thru publicity campaigns, kiosks, open houses and seminars and also
providing me its service.
I would be thankful to ADA, if I get admission thru this selection process, for helping me get into a medical school to make my dream of becoming
a doctor a reality.
If I get admitted I promise to be a disciplined and motivated student and do hard work to learn the art and science of medicine. I shall work for the
good of the mankind. I know every human life is precious and I promise to preserve and protect it.

I know it is a beautiful responsibility. I shall remember this and behave in a disciplined way, learn medicine, not get deviated or diverted from that
path and serve the humanity to the best of my ability.

Signature of the applicant: X____________________________________________________

Printed Name: Ms/ Mr _________________________________________________________ Date:

Sign of the parent / spouse X___________________________________________ Date:

Name and phone numbers of the parent/ spouse, who signed above: Mrs / Mr ___________________________________________ ______

Address: ____________________________________________ Cell Ph # ___________________

____________________________________________ Home Ph # ___________________

Please do not leave any blanks. >>>>>>>>>>> End of Application. <<<<<<<<<<<< Page 4 of 4
,LLC (ADA)
Study Medicine Abroad
Int’l Consultants & Placement Specialists, USA
Web: www.AmericanDreamAbroad.com Ph: 248-419-0284
Email: info@AmericanDreamAbroad.com or EasyMedSchool@yahoo.com 209-832-3111

Info sheet

Checklist

Please send
1) Application- completed and signed.
2) Diplomas from High School/ College (if ready) -- copies
3) Transcripts (if available- if not send later.)
4) Passport ‘photo page’ copy (for your exact name & number for the visa documents from the government, we get for you.)
5) 3 Photos (2”X 2”)
6) Application fee with a bank/ official check

If some documents are not ready/ pending, you can send now the application with the presently available documents and the fee
for speeding up the process.
You can send the other documents later when available. Don’t wait for them. (Early Bird catches the worm.)
Your schools or you can fax the transcripts to speed up the process followed by mail.
Send only copies. No documents will be returned from us.
We would be happy to take you into our reputed long lasting University Medical School program, if you meet the criteria.
We try to help all the applicants, who has the right attitude to enter into our noble medical profession to help others.

*****************************************************************************************************************************************

Ph: 248-419-0284
209-832-3111

Cell: 248-635-1110 (only if we are not available at the above numbers please.)

Email: (or) EasyMedSchool@yahoo.com (or) info@AmericanDreamAbroad.com

Please FEDEX your application to

American Dream Abroad, LLC


Doctors for Doctors
57 Menlo Park St
Mountain House, CA 95391
USA

Be the “early bird” for a better chance.


Keep this last page to yourself.

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