New Student Registration for American University of the Caribbean School of Medicine MERP

New Student Information

First Name*

Last Name*

Email*

Student ID*

Please enter your 9 digit ID number; include the @ symbol and all zeros that follow after (i.e. @00123456).

I will attend the April 2020 MERP Class*

Phone*

Housing Information

Please provide the following information about your housing plans so we can better assess your needs:

How did you find your housing?

Local Address

Street Address*

Address Line 2

City*

State/Province*

ZIP/Postal Code*

Country*

Phone

Room Choice*

In order to greatly reduce your cost of living expenses, you may want to strongly consider using the roommate finder function on the housing database which will be sent to you soon!

Please add detail*

Permanent Housing

Address

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Emergency Contact Information

Please enter a person we can contact in the event of an emergency.

Emergency Contact First Name*

Emergency Contact Last Name*

Emergency Contact Relation*

Emergency Contact Phone Number*

Emergency Contact Email*

Emergency Contact Address*

Address Line 2

City*

State/Province*

ZIP/Postal Code*

Country*

Type your name for signature*

By adding my name here, I certify that all the information above is correct to the best of my knowledge.