Eqaila , Block 6, Street 103, Building 2



College of Dental Medicine

Doctor of Dental Medicine program (DMD)

Academic Year 2023/2024

Request for an Application Form

First Name *
Middle Name *
Last Name *
Nationality *
Passport No *
Civil ID *
Civil Id Expiry Date *
Place of Birth *
Date of Birth *
Gender *
Mobile No *
Email *
Country *
City *
Block *
Street *
House/Building/Apartment No. *
Father’s Full Name *
Father’s Occupation *
Father’s Phone No *
Mother’s Full Name *
Mother’s Occupation *
Mother’s Phone No *
Name of Secondary School *
GPA Overall Score *
Graduation Date/ Expected Graduation Date: *
English Proficiency Test Type
Physics Score *
Chemistry Score *
Biology Score *
Financial Sponsor *
Certify the infromation *
I hereby certify that the information provided in this form is complete, true and accurate. I authorize AUMS and related officials to verify all statements contained therein. I give the university the absolute discretion to use these documents whenever and wherever it deems fit in connection with the admission process. Withholding information, misrepresentation, or forgery of the presented documents renders me subject to immediate dismissal from the university and all applicable legal penalties.