TRAINING & EDUCATION DEPARTMENT
www.uhs.ae
+(971) 6 505 8555
Clinical Attachment Program
Student's Information
Student Full Name
*
First Name
Middle Name
Last Name
Phone Number
*
Student's Phone Number
Format: (000) 000-0000.
Student's Email
*
example@example.com
Gender
*
Please Select
Male
Female
Academic Major
*
Please Select
Allied Health - Radiology
Allied Health - Dietitian
Allied Health - Medical Lab
Allied Health - Physiotherapy
Allied Health - Speech Therapy
Pharmacy
Medical
Nursing
Educational Qualification
*
Please Select
Bachelor Degree
Master Degree
PhD Degree
Diploma Degree
Select Training Department
*
Please Select
ER Department
Radiology Department
Family Medicine
Medical Lab
Physiotherapy Department
Pharmacy Department
Dietition Department
Speech Therapy Department
Upload the CV
*
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Upload the Evaluation Form from (DHA, SHA, MOH)
*
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DHA, SHA, MOH
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Upload the BLS Certificate
*
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Upload the Student's Emirates ID
*
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University Name
*
Awarding Institution
Requested Training Period
From:
*
-
Month
-
Day
Year
Date
To:
*
-
Month
-
Day
Year
Date
Additional Notes
Date
*
-
Month
-
Day
Year
Date
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