Graduate Medical Non-Degree Application

Biographic Information

Title/Salutation

First Name: *

Middle Name:

Last Name: *

Birthdate: *

Gender: *

The University of Miami prohibits sex discrimination in any education program or activity that it operates. Individuals may report concerns or questions to the Title IX Coordinator. The notice of nondiscrimination is located at www.miami.edu/titleix.

Contact Information

Email Address: *

Mobile Phone Number: *

Permanent Address: *

Country

Street

City

Region

Postal Code

Mailing Address: *

Same as Permanent Address: *

Country

Street

City

Region

Postal Code

Citizenship Information

Citizenship Status: *

Birth Country: *

Primary Citizenship: *

Dual Citizenship: *

Primary Citizenship (HIDDEN)

What is your passport number? *

Do you presently have a visa? *

Yes

Indicate the type of visa you hold *

Enrollment Questions

Term *

From what department will you be taking your non-degree courses? *

Have you obtained permission to take non-degree courses from this department? *

Yes

Supplemental Questions

Have you ever attended or are you currently attending the University of Miami? *

Yes

Student Campus ID number (C#):

Are you a University of Miami employee? *

Yes

Department's name: *

Rank (Faculty) or Job Title (Staff): *

Are you eligible for tuition remission as an employee? *

Yes

Learn more about tuition remission

If your tuition will be covered by an award, grant or external funding, please provide the source of funding with details (e.g. - If you have K grant funding enter the grant number, PI's name, grant title, etc.)

What are your academic aspirations, career goals and reason for applying for non-degree status?

Resume/CV

Please attach your Resume or CV in pdf format.

You may upload a PDF or Word Document. Please make sure your file is closed before uploading.

Undergraduate Institution

Institution Name: *

Degree: *

Date Conferred or Expected: *

Overall GPA: *

Upload Unofficial Transcript (PDF Only) *

Graduate Institution

Have you attended a graduate school? *

Yes

Institution Name: *

Degree: *

Date Conferred or Expected: *

Overall GPA: *

Upload Unofficial Transcript (PDF Only) *

Signature and Agreement

Student's Signature

Date