Antelope Valley Medical College | Quality Instruction In Allied Health Programs

Online Application

Already know what career path you would like to take? Then fill out our secure online form and you will become a student at AVMC in no time! * denotes required fields.

*Full Legal Name:

Last:	First:	Middle:

*Current Mailing Address:

Street:	City:	State:	Zipcode:

*Phone Numbers:

Home:	Work:	Cell:

Gender:

Male

Female

Date of Birth:

(MM/DD/YYYY)

*Email Address:

Major Academic Program:

Citizenship:

US. Citizen

Non-US.Citizen

Permanent Residence

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Student Visa - - - -

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Type:

Ethnic Identity:

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	American Indian / Alaskan
	Other / Non-white
	Pacific Islander
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Enrollment Status:

	First time college student
	First time AVMC (transfer student)
	Returning to AVMC

Is English Your
First Language?:

	Yes
	No

*Educational Background:

High School Graduate

1.Name of High School:
2.Date of Graduation:
3.Grade Point Average:

G.E.D.

1.Name of High School:
2.Date of Graduation:

College, universities, of other post-secondary schools attended

Institution #1	City/State	Dates Attended

Type of Program	No. of Credits Earned	Degree or Certificate Earned

Institution #2	City/State	Dates Attended

Type of Program	No. of Credits Earned	Degree or Certificate Earned

Contacts:

Fathers Name	Address	Phone Number

Mothers Name	Address	Phone Number

Spouse Name	Address	Phone Number

Emergency Contact:

Full Name	Address	Phone Number

*Do You Plan To Attend:

	Day Classes
	Evening Classes

Digital Approval:

I Agree to the statement below (Required to proceed):

All information provided is true and complete to the best of my knowledge. I understand that admission to the University of Antelope Valley is contingent upon submission of one of the following: official high school transcript, official G.E.D. test scores, or Ability to Benefit test scores and satisfaction of any additional admission criteria.

Academic Programs
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