San Juan Bautista School of Medicine Admission Payment Form

MD Admission Payment Form

To proceed with charging your credit card you need to fill out the following form
Name*

First NameMiddle NameLast Name (Paternal and Maternal Surname)
Last Four Digits SSN*
AAMC ID*
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Telephone Number*
Email*
example@example.com
Signature of Credit Card Holder*

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MD Program Admission Fee Supplemental Application
$100.00 Quantity

Total

$0.00
If you're facing any issues completing this form or with payment, please email finanzas@sanjuanbautista.edu
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MD Admission Payment Form