Please note that registration for MiniMed via online credit card will be unavailable between the hours of 11:00 PM to 11:59 PM (Eastern Time) on all Saturday, Sunday, and Wednesday nights, due to weekly scheduled system maintenance.

Tuition $125.00
Includes All Eight Educational Sessions

Wednesdays, February 7 til April 4
5:30 PM to 9:00 PM

Medical Science Building
185 South Orange Ave.
Newark, New Jersey 07101-1709

Registration for program must be done ONLY online and completed using online form.

Online registration should be made no later than Saturday, February 3rd.

Moneys are due no later than the first night of class February 7, 2018
For more information by phone: 973-972-1269
For more information by e-mail, contact Mr. Michael Grabow, Program Administrator at grabowmi@njms.rutgers.edu

Mini-Med School
Application Form

You may initiate registration by completing this form, choosing your payment type, and clicking on the "Complete Application" button at the bottom.

Note: The fields below marked with the red star * must be completed to process this form.

*Last Name:


*First Name:


 Middle Initial:






*Daytime Phone:


Evening Phone:


Fax:


*E-mail:






Student's Mailing Address

*Street:


*City:


*State:


*Zip Code:






Education Questions

*Are you currently a high school student?
Yes       No



*What is your age?



*What is your race?
African-American or African
Asian
Caucasian/White
Native American/Alaska Native
Native Hawaiian/Other Pacific Island
Other Non-Caucasian

Ethnicity:
Hispanic/Latino

I do not wish to answer these questions
*Which high school do you attend?
*What is your guidance counselor's name?
*What is your guidance counselor's phone number?

*What is your guidance counselor's email address?
*Are you currently attending a college/university or completing any sort of post-secondary education or certificate program, either part-time or full-time?
Yes       No



*Are you currently attending:
Full-Time       Part-Time


*Name of the college/university or institution you are currently attending


*Degree/certificate program you are pursuing


*Major or study concentration
*What is your profession or occupation?

*Please indicate your preferred choice of payment:

Credit Card/Electronic Bank Check       Check       Money Order

We accept only Visa or MasterCard, or Electronic Bank Check for payment.



Click on the button below to continue with the application process.





Please make your check out to:

NJMS-IPUHM (New Jersey Medical School - Institute for the Public Understanding of Health and Medicine)


Note: Checks must be submitted personally on the first night of the program. Please do NOT send any checks by mail to the school.


Please make your money order out to:

NJMS-IPUHM (New Jersey Medical School - Institute for the Public Understanding of Health and Medicine)


Note: Money orders must be submitted personally on the first night of the program. Please do NOT send any money orders by mail to the school.


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