Student Portal

APPLICATION FORM - MEDICAL IMAGING INTERNSHIP PROGRAM

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* Marked is Mandatory

Medical Imaging (6 Months Duration)

GMU Graduate

Outside Graduate

Academic Year *

Full Name (as per passport)

Address
*

P.O. Box
*

City
*

Country
*

Phone No. *

Email Address
*

Nationality
*

Gender

Male

Female

Valid passport with valid UAE visa

Yes

(For U.A.E nationals: Family Book)

Yes

Valid Emirates ID

Yes

Birth Certificate

Yes

Date of Birth

Visa Status

Provisional Degree

Yes

Year of Graduation

Degree Awarding Institute

Degree Attested

Yes

Transcript

Yes

Valid BLS & ACLS Provider Certificates

Yes

Malpractice Insurance

Yes

2 Letters of Recommendation

Yes

Letter of Good Standing

Yes

(BCG, HBV, Haemophilus influenzae type B vaccine, Tetanus)

Yes

P.O - Box : 4184 - Ajman, UAE.

Phone: (+971 6) 7431333

Fax: (+971 6) 7431222