FIVE YEAR UNDERGRADUATE MBBS PROGRAM APPLICATION

 

OUM Student Candidate Application

  
 

Supplemental Documents: Please arrange for your original or certified school transcripts and three letters of recommendation (one must be from a physician) to be mailed directly to:
Medical Education Services Australia Pty Ltd
Australian Agent for Oceania University of Medicine
Level 10, 50 Market St
Melbourne, Victoria, Australia, 3000

Application Fee: The application fee of US$100 must be received before your application is processed. A personal cheque or money order may be forwarded to the address above, made payable to Oceania University of Medicine (please do not write OUM.) To pay by credit card, information may be entered at the end of this application. Please make sure that all details are correct and complete (* indicates required information). If you have difficulty completing the online application, please click here to contact Medical Education Services Australia Pty Ltd, Australian Agent for Oceania University of Medicine.

     

 

 Personal Details  

 

Full Name: *

  

 

Date of Birth: *

  mm/dd/yyyy         
 

I am a citizen of: *

  
 

Country of birth: *

  
 

Visa Status:

  
 

Native Language:

  
 

English Language Fluency:

  

 

   Address  
 

Street Address: *

  
 

City: *

  
 

State, Province: *

  
 

Postal Code/ Zip Code / Pin Code: *

  
 

Country: *

  

 

   Contact Information
(please include the country code if outside the US or Canada)
  
 

Home: *

  
 

Mobile:

  
 

Work:

  
 

Facsimile:

  
 

Email Address: *

  

 

   Employment History (This is not necessarily a requirement)  
 

1. Employer:

  
 

Employed From (dates):

  Through:    
 

Position / Title:

  
 

2. Employer:

  
 

Employed From (dates):

  Through:    
 

Position / Title:

  
 

3. Employer:

  
 

Employed From (dates):

  Through:    
 

Position / Title:

  

 

   Academic Details/ History
(use the first or last day of the month if exact dates are unknown)
  
 

Admission Test Score - this may include: UMAT, MCAT, ICAT, OUMAT:

  
 

Date Taken:

  mm/dd/yyyy  
 

or Planned Test Date:

  mm/dd/yyyy           
 

Fellowships, Scholarships, or Other Honors

  
 

1. School Attended: *

  
 

Attended From (dates):

  Through:    
 

Aggregate percentage in VCE/High School * (must be numeric): *

  
 

2. School Attended:

  
 

Attended From (dates):

  Through:    
 

Aggregate percentage in VCE/High School (must be numeric):

  
    Letters of Recommendation will be forwarded from:  
 

1. Reference Name:

  
 

Reference Title:

  
 

Reference Telephone:

  Ext.   
 

Reference Address:

  
 

2. Reference Name:

  
 

Reference Title:

  
 

Reference Telephone:

  Ext.   
 

Reference Address:

  
 

3. Reference Name:

  
 

Reference Title:

  
 

Reference Telephone:

  Ext.   
 

Reference Address:

  
 

 

  
    General  
 

How did you hear of OUM (Ad, Letter, Postcard, Web, etc): *

  
 

Referred By (Name of Magazine, Search Engine, Person, etc):

  
 

Have you spoken with a representative from OUM? *
 

 
 

Are you comfortable using the computer for communications, study, and research purposes? *

  
 

Do you own a laptop computer? (This is not necessarily a requirement) *

  
 

Do you allow OUM to cross check information you have provided in this application ? *

  
 

If you are accepted by OUM, what starting date would you prefer? *

  
 

Please check all details are correct and complete.

  
 
 
 
     
 


 

 
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