Personal Information: Please complete all required fields in the application. When you are finished with all the screens, please click on the "I am Finished -Submit" button located at the bottom of the page.

Note that a $30 application fee is required as part of the application process.

Personal information such as name, address and e-mail address
Title
 Title to your Name 

First Name
Middle
Last

Suffix
 Enter in the persons suffix 

Any Prior Last Name(s)

Prefered Name (NickName)

Date of Birth
  (mm/dd/yyyy)

Street Address

(Continued)
 Use if more space is needed 

(Continued)
 Use if more space is needed 

City

State / Province
 Enter the proper value for selected country 

Postal Code
+ 4
 Zip code + 4 

Country
 Changing this will refresh page 

Phone
Area
Phone
 Format (xxxxxxx) No Dashes

Phone (2)
Area
Phone
 Format (xxxxxxx) No Dashes 

Email Address

Government ID-SSN
 Format (xxxxxxxxx) No Dashes

Country of citizenship

Begin Study In...
 Enter the term to begin study 

Residence Country

Residence State / Province
 Enter in the persons State of Residence 

Residence County
 Enter in the persons County of Residence 

How did you hear about SHMS?
 Select source that led you to us 


    required and     optional