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Community > Public Education Mini Med School: Register
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Registration is currently closed for MiniMed.

Mini-Med School Application Form

Tuition: $100.00
Optional Meal Plan: $25.00

You may initiate registration by submitting this form. You will be contacted confirming registration and receipt of payment. You can also print this page and make a check or credit card payment to:

NJMS Institute for the Public Understanding of Health and Medicine

(NJMS-IPUHM)

Printed registration forms should be mailed or faxed to:

Ms. Stefanie L. Napolitano
UMDNJ-New Jersey Medical School
Office of Special Programs
185 South Orange Ave., MSB B-624
Newark, NJ 07101-1709

Phone: 973-972-9074
Fax: 973-972-3768
napolist@umdnj.edu

*Please note that payment is REQUIRED before the first class.

 

Last Name
First Name
Middle Initial 
Degree

Daytime Phone
Evening Phone
Fax
E-mail


Street
City 
State
Zip

We accept Visa or MasterCard for payment.

Please enter your credit card number:

Please enter the expiration date:
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Please type the name as it appears on your card below:

  I wish to purchase the optional meal plan for an additional $25.00

Attention: Once you select the button below, you have applied to the chosen certificate program and your credit card will be charged. This is a nonrefundable fee. Do not select the button below unless you want this to be done.


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