New Acupuncture/Massage Online Application

Acupuncture/Massage Online Application

Todays’ Date

First Name

Last Name

Gender

Gender - If Other

Birth Date

Alberta Student Number (if known)

Street

City

State/Province

Zip/Postcode

Country

Home Phone

Cell Phone

Program

Enroll In

Choose Option

If select the other, please explain

Immigration Status:

For International Students

Visa Exp. Date

Country of Citizenship

Do you have a current English proficiency test result (TOEFL/IELTS)?

Yes No Not Selected

If yes, the score

Education History

1. School Name

City

Period

Academic Level Achieved

2. School Name

City

Period

Academic Level Achieved

Attach High School and/or Post Secondary transcripts/diploma

Previous/Current Employment
Upload resume or fill out the fields below

Resume

1. Employer

City

Period

Position

Reason Left

2. Employer

City

Position

Reason Left

Related Training/Experience (Optional)

1. Training Name

City

Period

Position

2. Training Name

City

Period

Position

References
Upload reference letters or fill out the fields below

Reference letter #1

Reference letter #2

1. Name

Professional Title

Origination/Institution

Contact Phone

2. Name

Professional Title

Origination/Institution

Contact Phone

Do you require any disability accommodation?

Yes No Not Selected

If yes, we may require a medical note/assessment from physician, occupational therapist, etc.

How will you finance yourself while attending the program?

Personal Letter of Intent (Or attach it separately to your email with this form)

Enter the above code

Required

Acupuncture/Massage Online Application

For International Students

Education History

Previous/Current Employment Upload resume or fill out the fields below

Related Training/Experience (Optional)

References Upload reference letters or fill out the fields below

Previous/Current Employment
Upload resume or fill out the fields below

References
Upload reference letters or fill out the fields below