SOLICITUD DE ADMISION ESCUELA DE OPTOMETRIA
 APPLICATION FOR ADMISSION SCHOOL OF OPTOMETRY

Nombre e Inicial/First Name & Inicial
Primer Apellido/Father's Surname
Segundo Apellido/Mother's Surname
Seguro Social/Social Security
Sexo
Fecha de Nacimiento/Date of Birth (Mes/Month/Día/Day/Año/Year)

Lugar de Nacimiento/Place of Birth
Dirección Postal/Mailing Address
Zona Postal/Zip Code
Dirección Residencial/Home Address
Zona Postal/Zip Code
Teléfono Residencia/Home Phone
Teléfono del Trabajo/Work Phone
E-mail

Eres ciudadano americano/Are you a U.S. Citizen?
 If No Alien#:


  OAT Exam/Examen OAT Fecha que tomó el examen/Date exam was taken:  
  Tipo de Admisión  
       

Semestre al que solicita admisión

  Meses     
Código de institución universitaria: (Si solicita admisión como estudiante transferido)/Transfers Only
Persona a notificar en caso de emergencia:
Número de teléfono (Area Code, Núm. Telefónico) 

Medio que influyó en la decisión de seleccionar la Escuela de Optometría de la
Universidad Interamericana de PR para estudiar
What influenced your decision to study at the Inter American University of Puerto Rico
School of Optometry

Entre su historial académico/Enter your academic history college, dates attended, graduation date and degree)

Entre sus honores académicos/Enter your academic awards

Mencione las organizaciones y actividades extracurriculares, incluya las fechas en que participó a

nivel de escuela superior y universidad/List organization and extracurricular activities including dates

of partipated in school and colleges activities.

Experiencias de Trabajo/Work Experience

Answer in English: The reasons why you want to study Optometry.

Answer in English: What are your plans if your application is rejected?

Two letters of recommendation by professors from the following areas: Biology, Chemistry, Physics, and Math. The letters
should be send directly to the Admissions Office.

To be considered for admission, the applicant must have completed at least 90 semester credit hours (or their equivalent) at an accredited university. Among those credits, the following courses should be included. (Indicate if you have taken the courses or not.)

General Biology (6 credits)      Microbiology (4 credits)        
Calculus (3 credits)                  General Physics (8 credits)     
English (6 credits)                    Biochemistry (3 credits)
General Chemistry (6 credits)   Organic Chemistry (4 credits) 
Statistics (3 credits)                  General Psychology (3 credits)
Humanities (6 credits)              Social Sciences (6 credits)   
Before you send this application please be sure that (Please Check):
 The application is sent on time
 A certified check or money order for $31.00 is included.
 Official transcript from all colleges have been requested to be sent to the School of Optometry
 QAT has been taken and an official scores copy has been requested to be sent to the School of Optometry, if not
        taken, indicate when you plan to take it.
 Two letters of recommendation from a past Biology, Chemistry, Physics, or Math professor have been requested
        to be sent to the School of Optometry.
 One letter of recommendation from an Optometrist
 Health certificate
 Immunization record including Hepatitis B vaccine

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Credit Card Visa MasterCard

Credit Card Number

Expiration Date
 

 


Certificación

Afirmo que toda la información suministrada en la presente solicitud  es correcta, veridica y completa; que el solicitante entiende que assume la obligación de respetar las normas y reglamentos existentes en la Universidad Interamericana así como los que de tiempo en tiempo fueren aprobados por las autoridades universitarias correspondientes, así como que la violación de dichas normas es susceptibles de acción disciplinaria, incluso la suspensión permanente del estudiante cuando la gravedad de la violación lo amerite.

Hago constar que aceptamos que la obligación de la Universidad es ofrecer aquellos cursos o asignaturas específicas para las cuales se matricule el estudiante en cada semestre o sesión de verano, pudiendo la Universidad descontinuar cualquier programa académico cuando asi lo entienda necesario o conveniente.

Los que suscriben, solicitante y/o padre, madre o encargado  del mismo nos hacemos responsables de los actos y conducta del solicitante y mancumunada y solidariamente de los compromisos económicos que él contraiga durante su estadía en la Universidad Interamericana de Puerto Rico.

Cualquier declaración falsa, engañosa o incompleta contenida en la solicitud de admisión anularía la aprobación de la solicitud y liberará a la  Universidad Interamericana de toda obligación que hubiera contraido a base de la información sometida en la solicitud.

La aprobación de esta solicitud de admisión por la Universidad Interamericana y el pago por usted de los derechos de matrícula le obliga a usted por solamente el semestre para el cual usted hubiera hecho el pago.  Asimismo, la aprobación  de esta solicitud y la aceptación del cargo de matrícula, obliga a la Universidad Interamericana por ese mismo término, sujeto a los reglamentos aplicables.  No obstante, no sera necesario que usted haga nueva solicitud de admisión a la terminación de cada semestre o sesión académica, sino que la mera aceptación por la Universidad Interamericana del pago de la matrícula y de cualquiera otros derechos que se fijasen operará para extender la obligación recíproca creada en la forma antedicha de semestre en semestre.

Todo documento sometido para establecer elegibilidad a admisión se convierte en propiedad permanente de la Universidad Interamericana de Puerto Rico y no se devuelve.

Certificate

I affirm that all information contained herein is correct, true and complete; that the applicant understands that he assumes the obligation of abiding by the rules and regulations existent at Inter American University, as well as those that from time to time may be approved by the University authorities, and that the violation of said rules, is subject to disciplinary action including permanent suspension of the student when the seriousness of the violation may so justify.

I hereby acknowledge that the obligation of the University, is to offer the specific courses or subjects in which the student officially registers each semester or summer session, and the University may discontinue any academic program whenever it considers necessary or convenient to do so.

The undersigned applicant and/or father, mother or guardian of same, assume responsibility for the acts and behavior of the applicant and jointly and severally, of the economic obligation he/she may incur during  his/her enrollment at the Inter American University.

Any false, misleading or incomplete statement contained in the application for admission will annul the approval of the application and will release Inter American University from all obligations that it might have contracted based on the submitted application.

The approval by Inter American University of this application for admission and your payment of the registration fees bind only you for the semester for which you have paid, likewise the approval of this application for admission and the acceptance of your payment of the registration fees bind the University for the same period of time subject to the applicable regulations.  Nevertheless, it will not be necessary to reapply for admission at the end of each semester or academic session, since the acceptance by the Inter American University of the payment of registration and of any other fees that might be established, will serve to extend the reciprocal obligation described above from semester to semester.

All documents submitted to establish eligibility for admission become permanent property of the Inter American University of Puerto Rico and are not returnable.

 

Derechos Reservados © 2002 Universidad Interamericana de Puerto Rico-Escuela de Optometría.
Revisado: November 09, 2004