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Acknowledgement and Confirmation Form

By submitting this Acknowledgement of Acceptance and Confirmation form, I agree to do the following:

• Submit the non-refundable $500 deposit within two weeks of receipt of acceptance letter (applied towards tuition)
• Complete the required immunizations, background check and drug screen prior to May 1
• Provide proof of individual or family medical insurance or purchase the available MSM Student Healthcare Plan
• Submit any outstanding final official college or university transcripts prior to matriculation
• Submit any outstanding program admissions requirements (pre-requisites, direct patient care hours, etc.)
• Attend all four (4) Meet & Greet sessions 
• Attend Jump Start program TBD
• Attend program Orientation TBD
• Complete all Pre-Matriculation program academic modules and activities

If you see this don't fill out this input box!

*I agree to all of the above requirements

* I agree to all of the above requirements

*First Name

*Last Name

*CASPA Identification Number

*Email

*Phone

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