Georgetown American University
Georgetown American University (GAU) - Application Form
Personal Details
First Name
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Last Name
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Email
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Postal Address:
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Street: City: Zipcode:
Country
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Cell Phone No.
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HAVE ANY MEMBERS OF YOUR FAMILY ATTENDED THE GEORGETOWN AMERICAN UNIVERSITY?
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Yes
No
WHAT IS YOUR LINKEDIN PROFILE ADDRESS?
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WHAT IS YOUR FACEBOOK PROFILE ADDRESS?
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PROFILE PICTURE (ONLY A PASSPORT SIZED PHOTO 4.5 X 3.5 CM ACCEPTABLE)
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Please upload image file.
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Program of Interest
DESIGNATE YOUR INTENDED MAJOR:
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Premedical Sciences
MD-Preclinicals
MD-Clinicals
THIS APPLICATION IS FOR:
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Select
Winter 2019
Summer 2019
Fall 2019
Winter 2020
Summer 2020
Fall 2020
ARE YOU A TRANSFER STUDENT?
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Select
Yes
No
IF YOU ARE A TRANSFER STUDENT, SELECT THE LAST PROGRAM COMPLETED AT YOUR PREVIOUS MEDICAL SCHOOL.
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Premed II
Premed III
Premed IV
MD1
MD2
MD3
MD4
MD5
Clinical Sciences
eg. Premed II is the 2nd term of Premedical Sciences, MD 1 is the 1st Preclinical Sciences (Basic Sciences) term, MD 5 is the last Preclinical Sciences term etc.
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Emergency Contact
Emergency Contact Name
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Emergency Contact Telephone Number
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Emergency Contact Relationship
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Select
Mother
Father
Sibling
Spouse
Friend
Other
Emergency Contact Email
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Education
Name of High School
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Address
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Street: City: Zipcode:
Country
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Graduation Date
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Tertiary Institution Name
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List the most recient College/University attended
Address
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Street: City: Zipcode:
Country
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Major
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Graduation Date
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Tertiary Institution Name
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List any additional tertiary Institution(s) attended
Major(s)
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List the name of qualifications obtained from above mention institution(s)
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Academic Records: Upload all required information below. If unable to do so at this time kindly email the documents to admissions@gau.edu.gy. This application cannot be processed until all required documents are on file.
Copy of Your CV
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Upload Academic Record I
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Professional Certifications/Degrees
Upload Academic Record II
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Upload Academic Record III
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Copy of Transcript/Grade Sheet
Upload Academic Record IV
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Upload Government Issued Photo ID
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Upload Letter of Recommendation I
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Upload Letter of Recommendation II
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Upload Personal Statement
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Certification
I hereby certify that the above information including attached files are true and correct to the best of my knowledge. I understand that a falsified information will affect my enrollment at GAU.
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Signature
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Date
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HOW DID YOU LEARN ABOUT US?
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Social Media
Agent
Current Student
Staff
other
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