Corinthian Naturopathic College

  Application For Admission

         I, _______________________________________________________hereby apply for admission to

         Corinthian Naturopathic College this ________day of ____________________________20_____

         I REQUEST ENROLLMENT IN:     

                                                   ___ Doctor of Naturopathy (N.D.)

                                                   ___ Bachelor of Science in Naturopathic Ministry (B.S.N.M.)  

                                                   ___ Certificate in Colon Hydrotherapy (C.C.H.)

         Applicant’s Full Name:               Mr.                                Ms.

         ___________________________________________________________________________________

                  Last                                          First                                      Middle

         Home Address (Including Apt. No.) ___________________________________________________

         City, State, ZIP _____________________________________________________________________

         PHONES:  Home (_____) ______________________ Work: (_____) _________________________

                         Fax: (_____) ______________________ E-mail: ________________________________

         Driver’s License Number: _______________________________ State: ______________________

         Current Occupation: ___________________ Company ________________ How Long: ________

         City, State, ZIP: ____________________________________________________________________

         Date of Birth___________________)______ Social Security Number: ______________________

         Name, Address, Telephone & Relationship of closest relatives not residing with you.

         ___________________________________________________________________________________

         ___________________________________________________________________________________

         EDUCATION

         Primary & Secondary:

         Circle Highest Grade Completed:   1    2    3    4    5    6    7    8    9    11    12    or    GED

         College Education:

            Name of School                   Degree or Major            Credits                Degree Earned

        (A) _________________________________________________________________________________

        (B) _________________________________________________________________________________

        How did you become interested in Natural Health and why have you chosen CNC?

        ____________________________________________________________________________________

        ____________________________________________________________________________________

        How do you expect to use your education in the field of Natural Health? ________________

         ___________________________________________________________________________________

        ____________________________________________________________________________________

         Print your name on the line below as you would wish to appear in your diploma.

         ___________________________________________________________________________________

         Please include a recent passport style photograph with this application. Please type or

         print in black ink.

         I certify that the above information I have provided is true and correct. I understand that

         if I misrepresent information or provide untruthful information, it can result my acceptance

         to Corinthian Naturopathic College being declared null and void. I agree to abide by the

         rules and procedures of the Corinthian Naturopathic College.

        Signed_______________________________________________ Date__________________________

        ____________________________________________________________________________________

        PAYMENT OPTION

          PAYMENT IN FULL

        10% discount will apply to your tuition with this option

        I am making a payment of $______________________

         INTEREST FREE PLAN

                        Down payment $___________                   Monthly payment $_____________

         ___ I am paying by check or money order.

         ___ I am paying by credit card.  Please bill my:

         ___VISA                  ___MasterCard                ___American Express              ___Discover

        Credit Card #_________________________________Exp.___________________ CVC # _________

        Name on Account____________________________________________________________________

        Signature____________________________________________________________________________

Copyright this business. All rights reserved.

Web Hosting by Yahoo!