TRAINING & EDUCATION DEPARTMENT
www.uhs.ae
+(971) 6 505 8555
Undergraduate Program Request Form
Student's Information
Official Letter
*
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Student Full Name
*
First Name
Middle Name
Last Name
Other Student's Name List:
Phone Number of Requestor
*
Student's Phone Number
Format: (000) 000-0000.
Email of Requestor
*
example@example.com
Gender
*
Please Select
Male
Female
Student's Major
*
Please Select
Allied Health - Radiology
Allied Health - Dietitian
Allied Health - Medical Lab
Allied Health - Physiotherapy
Allied Health - Speech Therapy
Allied Health - Pharmacy
Medical
Nursing
Admin
Upload the BLS Certificate
*
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Upload the Student's Emirates ID
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Year of Study
*
Please Select
1st Year
2nd Year
3rd Year
4th Year
Internship
University Name
*
Requested Training Period
From:
*
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Month
-
Day
Year
Date
To:
*
-
Month
-
Day
Year
Date
Additional Notes
Date
*
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Month
-
Day
Year
Date
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