RAK Medical and Health Sciences University
Ras Al Khaimah, UAE
P.O. Box 11172, Ras Al Khaimah, UAE Tel: +971-7-2269999 Fax: +971-7-2269998
Email: Website:

Note: Applicants are requested to read below mentioned points carefully before filling the application form.

Online Course Applied for *
Lifestyle Medicine
Lifestyle Management

Personal Detail

Name of the Applicant (*)
(In block letters as in passport)
Date of Birth (*)
Sex (*)  


Passport Number (*)
Date of Issue (*)
Date of Expiry (*)
Nationality (*)
Languages Known (*)

Contact Details

Student's Mobile No. (*)
Parent / Spouse's Mobile No. (*)
Student's Email ID (*)
Current Address for correspondence (*)
City (*)
PO Box (*)
Country Of Stay (*)
Are you Sponsored candidate Self-Financed
Sponsor Details, if you are sponsored Candidate

Parents / Spouse Details

Father Name (*)
Spouse Name

Educational Details

Examination PassedAggregate PercentageYear of PassingInstitution
High School *
Bachelor Degree *
Any Academic / Professional / Extra Curricular Achievements

Work Experience

Are you currently employed? Yes NO
If Yes, Company Name:
OrganizationPosition HeldTenure

Please Attach following Documents * 

Attach copy of High School
Attach copy of Degree Certificate
Attach copy of the Passport with VISA if in GCC
Recent Passport Size Color Photograph

Note: Maximum size of attachment 2 MB in .pdf, .docx and .jpg

  • The particulars stated in this application are true.
  • If selected for admission, I promise to abide by the rules and regulations of the Institute.
  • I shall attend the contact classes & examinations.
  • I shall sincerely & seriously devote in equipping myself with expected Academic, Value and Skill sets required for me.
  • I undertake to pay the fees regularly for the completion of the course.


I hereby declare that above mentioned information is true.


1. Incomplete forms will be rejected.
2. Institute reserves right to cancel admission of a candidate at any stage if and when it is detected that the admission is obtained by concealing material facts.
3. Scanned Self Attested photo copies of High School & Degree marks and certificates should be enclosed along with the form.
4. Life Style Medicine Program is only for science graduates and Life Style Management program is for graduates in any discipline.
5. Program is fully conducted in English including Examinations.