PROFESSIONAL COURSE APPLICATION


Name: ________________________________________________________________

Address: ______________________________________________________________

City, State, Zip: _________________________________________________________

Phone: ______________________________   E-mail: __________________________

Applying for Level (circle one):     1        2        3        4


Education:  List schools attended, degrees earned, and dates.  Include professional certifications and licensures.
Please attach, or send under separate cover, transcripts from higher education institutions.







Previous experience with homeopathy, if any:














Personal statement: On a separate page, please write a brief statement about your reasons for taking this course, your aspirations in relation to homeopathy, and your thoughts about what this education might mean for you.

FINANCIAL INFORMATION

Beginning any academic year in the school constitutes an implied financial commitment for that entire year. Refunds and/or release from this financial responsibility will be given only when a student must drop out due to serious extenuating circumstances. 

Additional educational experiences, such as Anatomy/Physiology/Pathology and private clinical supervision, may be offered for an additional fee.


Payment plan (check one):

___  Option 1: A single payment of $3200, due at the first class meeting in September.

___  Option 2: Two payments of $1700 each, one at the September class meeting and one at the January class meeting.

___  Option 3: Nine automatic payments of $400 each by credit card, monthly from September to May.


Credit card information is required for Option 3 only.


Visa/MC number: ________________________________  expiration: ________

Name on card: ____________________________________________________

Signature: ________________________________________________________



A deposit of $300 must accompany the application to hold a place in the course. The deposit will be applied to the first payment and will be returned in the event the student is not admitted to the school.

____ Deposit check for $300 is enclosed.

____ Please charge the deposit to my credit card.



I understand and agree that my matriculation implies a financial commitment for the entire academic year. I agree to pay the tuition for the year in the method specified above.


Signature and date: _________________________________________________


APPLICATION CHECKLIST
PROFESSIONAL COURSE


___  Application cover page

___  Personal statement

___  Financial page, signed

___  Deposit (by check or credit card)

___  Transcripts (may be sent under separate cover)




The complete application is due August 15. Transcripts may arrive later but should be ordered when the application is submitted.











Please return to Florida Academy of Classical Homeopathy

Mailing address: P.O. Box 4047, Deland FL  32721-4047

Phone and fax: 386-736-8685