NUKS ID Application

The application will NOT be processed if any field is not fully completed!
Invalid fields will be highligted in red and yellow

First Name
Please capitalize first letter. Ex: Mohammed

Full Middle Name (Not Just Middle Initial)
Using middle initial only will cause your application to be DISCARDED!
Please capitalize first letter. Ex: Mohammed

Last Name
Please capitalize first letter, and use a dash "-" between "Al" and last name. Ex: Al-Mohammed

Date of Birth
Please use MM/DD/YYYY format. Ex: 07/15/1985

Country of Citizenship
Please capitalize first letter. Ex: Kuwait

Major / Specialty / Occupation
(type Patient if you are a Kuwaiti citizen receiving a treatment in the U.S.)
Please write in full--no abbreviation, and capitalize first letter. Ex: Mechanical Engineering
Applications with abbreviated descriptions will be IGNORED!

Level

School Name / Employer / Hospital Name (For Patients Only)
Please write in full--no abbreviation, and capitalize first letter of every word
Ex: California State University at San Diego
Applications with abbreviated descriptions will be IGNORED!

Street
Please capitalize first letter of each word

City
Please capitalize first letter of each word

State
Please use 2 letter state cod.

Zip Code
5-digit Zip Code

Country
Please capitalize first letter

U.S. Phone
Use the format (640) 5555-1212

Kuwait Phone
Use the format 99554444

Primary Email
Please use all small letters. Ex: user@mail.com

School or Secondary Email
Please use all small letters. Ex: user@school.edu

Password
Password must be more than 6 characters long

Reconfirm Password