University of Pittsburgh

School of Medicine

Student Affairs

This is not an electronic application. This is a request for application only.

After completing this form, you will be directed to secure online payment collection of the application fee. The non-refundable domestic application fee is $25. 


When your payment is processed, an official application will be sent to you at the email address you provide here.
To ensure you receive the application and all communications from UPSOM Student Affairs, add '' and '' to your trusted senders list. (If you use Gmail, add us to your Contacts)

Please visit the UPSOM Office of Student Affairs' Visiting Student Program webpage for information about the application process and requirements: 


Any questions should be sent to:

Due to the high volume of applicants, NO PHONE CALLS, PLEASE.



Student Application Request
FirstName is required
LastName is required
School is required
Expected Graduation is required
Address Line1 is required
City is required
Country is required
State is required
Zip is required
Phone is required
E-mail is required
Academic year is required
UPSOM period is required
Select UPSOM period or alternate period
Start date is required
End date is required

Fields marked with * are mandatory

A non-refundable amount of $ application fee is required to finalize the process.

This fee must be paid by either credit or debit card.

E-Mail additional information to the UPSOM Student Services Office.

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