APPLICANT INFORMATION AND PREFERENCES

Applicant's full name

First Name

Last Name

Gender

Male

Female

Country of birth

Father's name

First Name

Last Name

Country of birth

Full address

City

State/Province

Zip/Postal

Country

Telephone number

Passport number

Personal identification and Cuban ID (if applicable)

Passport issuance date

Date of birth

Citizenship

Current Occupation

Student

Medical Doctor

ACADEMIC BACKGROUND

Current Occupation

Baccalaureate Degree

University graduation date (baccalaureate or equivalent level)

Institution which certified your studies

Name and address of the university/ medical science faculty to which you belong to

Other medical studies/ training you are currently enrolled in or you have concluded:

Are you a certified medical practitioner?

Yes

What is your medical specialty?

(Describe / If not applicable, please enter "None")

What medical institution/ research facility do you belong to?

(Describe / If not applicable, please enter "None")

Date of graduation

(pre-university/ high school or equivalent)

Additional notes

REQUESTED ACADEMIC PROGRAM DETAILS

Postgraduate Program

Please visit https://chmt-la.mx/diplomas-training-courses-visits-fellowship-and-internships/ and select the exact program you are interested in

If you are interested in Visits, Residency, or Internships programs, please furnish full details

(Describe / If not applicable, please enter "None")

If interested in a Doctoral program, state the Research topic

(should be related to scientific subject of the country of origin of the applicant)

First enrollment date preference

Enrollment total number of weeks

(for training programs only)

Second enrollment date preference

Enrollment total number of weeks

(for training programs only)

Third enrollment date preference

Enrollment total number of weeks

(for training programs only)

Is Spanish your mother tongue?

Yes

Please be aware, for Non-Spanish speaking students, you would be required to enroll in a 3 months Spanish course

PAST RESIDENCY DETAILS

In the past, have you been enrolled in any educational program in the Republic of Cuba?

Yes

Please type in the date you have departed the country?

Please choose the mean of departure?

By air

By marine

CONTACT PERSON IN CASE OF EMERGENCY

Full Name

First Name

Last Name

Relationship

Phone Number

Full Address

City

State/Province

Zip/Postal

Country

ACCOMMODATION PREFERENCE

Note: Accommodation in a university residence is compulsory for the entire duration of the six-month Spanish language program designed for non-Spanish-speaking postgraduate students. Those enrolling in this postgraduate Spanish program must reside at Marina Hemingway / Comodoro.

Accommodation preference

Do you prefer to live alone?

Yes

Upload

If you are interested in Visits, Residency, or Internships program(s), please disregard the upload section below

Copies of entry registration or medical license status

Maximum file size: 268.44MB

Copies of pre-university studies 1

Maximum file size: 268.44MB

Copies of pre-university studies 2

Maximum file size: 268.44MB

Certified and legalized copies of Immunization report

Maximum file size: 268.44MB

POLITICAL AFFILIATION

Are you affiliated to any political party?

(Describe / If not applicable, please enter "None")

Do you have any political or socioeconomic beliefs

(Describe / If not applicable, please enter "None")

Do you have any background regarding the Republic of Cuba, the Cuban revolution

(Describe / If not applicable, please enter "None")

HOBBIES AND INTERESTS

What hobbies do you regularly practice?

While at school, have you participated in any national or international educational and/ or sporting events?

(Describe / If not applicable, please enter "None")

IMPORTANT NOTICE REGARDING THE INITIAL DEPOSIT

Effective August 1, 2015, CHMT will require a non-refundable application fee of $200.00 for the submission of the Student Application for Admission into a Postgraduate Medical Program to the Cuban Academic Services Authorities (CASA) for assessment and determination of suitability.

This policy has been implemented due to a pattern we have observed: a number of applicants who received enrollment approval were only seeking free consultations and had no genuine intent to pursue academic studies. We consider this practice unfair for the following reasons:

The Cuban Academic Services Authorities (CASA) dedicate time and resources to reviewing each application.
Application processing may result in the temporary allocation of enrollment or visitation slots, which can delay opportunities for other serious candidates.

PLEASE NOTE:

CHMT’s payment processing is conducted through our sister company, CHMT Canada Inc. As such, your credit card statement will reflect CHMT Canada Inc. as the payment recipient.

CHMT Education Team

Agreement Confirmation

I confirm that I have read and agree to the information provided above.

Payment ( $200 )

APPLICATION FOR ADMISSION INTO A POST-GRADUATE MEDICAL PROGRAM

Programas de tratamiento

Educación

OFFICIAL STUDENT APPLICATION

APPLICANT INFORMATION AND PREFERENCES

ACADEMIC BACKGROUND

REQUESTED ACADEMIC PROGRAM DETAILS

PAST RESIDENCY DETAILS

CONTACT PERSON IN CASE OF EMERGENCY

ACCOMMODATION PREFERENCE

SELECT ANY MEDICAL CONDITIONS THAT APPLY TO YOU (or check ‘None of the above’)

Upload

POLITICAL AFFILIATION

HOBBIES AND INTERESTS

IMPORTANT NOTICE REGARDING THE INITIAL DEPOSIT

Payment ( $200 )

CHMT Medical Tourism INC

Customer Care Services (24h/7)

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