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Application Form
Instructions:
Please print and complete the following application and email or mail to:
The University of Natural Medicine
P.O. Box 3300
San Dimas, CA 91773
info@universitynaturalmedicine.org
Please print clearly or type. Due to the individualized, self-directed nature of our programs, please complete this application carefully and thoroughly as this application identifies who you are academically, professionally, and personally. This application form will be regarded as confidential and used only in the admission process and by appropriate University officials. Use a separate sheet of paper when necessary.
Personal Data
Name: Mr./Ms./Mrs./Dr./(Last)_________________________(First)___________(MI)____
Maiden Name ___________________________________________________________
Present Address: _________________________________________________________
(City)_________________________(ST)_____(ZIP)_________(Country)_____________
S.S.#:__________________________________________________________________
Date of Birth: (Month)________________________(Day)__________(Year)__________
Phone(H):__________________________(Best time to call)_______________________
Phone(W):__________________________(Best time to call)______________________
Cell #____________________________________________________
E-Mail Address:__________________________________________________________
Present Occupation/Title:___________________________________________________
Employer/School:_________________________________________________________
Citizenship:_________________________ Native Language:______________________
Languages Spoken Fluently: ________________________________________________
Degree/Diploma I am seeking (circle one)
Bachelor of Science in Natural Health Sciences (B.S.)
Master of Science in Natural Health Sciences (M.S.)
Master of Arts in Body/Mind Integrative Studies (M.A.)
Doctor of Philosophy in Natural Health Sciences (Ph.D.)
Doctor of Integrative Medicine (I.M.D.)
Doctor of Integrative Medicine (For Health Professionals)(I.M.D.)
Doctor of Natural Medicine(D.N.M.)
Doctor of Natural Medicine (For Health Professionals)(D.N.M.)
Doctor of Naturopathy (N.D.)
Doctor of Naturopathy (For Health Professionals)(N.D.)
Doctor of Philosophy in Clinical Psychophysiology (Ph.D.)
Major or Concentration:____________________________________________________
Diploma Program:_________________________________________________________
Employment
List most recent first. If available, please enclose a copy of your most recent resume.
Employer/Address Dates from/to Position/Title
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Community/Volunteer Activities
List most recent first. Please use a separate piece of paper if necessary.
Employer/Address Dates from/to Position/Title
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2.
3.
List of Associations, Memberships, or Organizations
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Comments
Briefly describe the most important job skills and interpersonal skills you have developed through work or activities.
Incoming Credit
The University accepts incoming credit toward a student's first undergraduate degree program. Not only is relevant academic credit considered, but the University recognizes that individuals learn on their own or through their work as well. Thus, incoming credit may be considered for life and work experience. If you are applying for incoming credit for life and work experience, please submit your portfolio for incoming credit with your application.
I am applying for Incoming Credit from my academic transcripts. yes no
I am applying for Incoming Credit from my work experience. yes no
Education
1. Undergraduate/Graduate Institutions:
Begin with last attended. Please use a separate sheet of paper if necessary. Official transcripts must be received as soon as possible. However, copies of your transcripts are acceptable initially for the evaluation process. All transcripts must be received for a complete evaluation.
Name/Address Dates Degree Credits Earned
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2. List Publications, Honors, Awards:
3. Comments:
Briefly describe the challenges and accomplishments of your educational experience.
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Check List
1. If not included please indicate which items are being sent separately:
____ Completed Application Form
____ Official Transcripts (copies are acceptable for initial evaluation)
____ Two-Three Page Essay
____ Evaluation Fee: $50.00
____ Three (3) Passport Size Photos (Taken Within Five Years)
____ Payment Options (Financial Information) Sheet
____ Incoming Credit Portfolio (If Applicable)
2. I am sending official transcripts from:
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Essay
Your essay, along with you completed application, is an opportunity for the University to assist you in the process of designing your program and educational goals to best fit your individual needs. Because the programs offered require the student to work more independently, communication and writing skills are emphasized. Your essay will be an important tool for the admissions committee to identify areas of strength as well as areas where added focus and attention would improve your academic and professional career. Please address, but don't limit yourself to, the following areas in your essay. It should be no more than 2-3 double spaced, typed or word processed pages.
1. Reflect upon your personal and professional history. How has this influenced your growth and contributed to your decision to seek admission to the University of Natural Medicine and to the program(s) of your choice?
2. Your most valuable asset is your life experience. Our programs are designed to help you to build upon your own experiences and special talents. Above all, we value your special individuality and ability to reflect upon your own life and learning. What have been your most valuable learning experiences and how do you incorporate these experiences into your life?
3. How do you view yourself and what do you value most about your self? What are the challenges you might face in order to successfully complete your course of study? What are your goals, dreams and visions for the future and what do you plan to do with the degree or diploma you seek from the University?
I CERTIFY THAT THE INFORMATION ON THIS APPLICATION IS COMPLETE AND ACCURATE. I UNDERSTAND THAT ANY MISREPRESENTATION MAY BE CAUSE FOR REJECTION OF SUBSEQUENT DISMISSAL FROM THE UNIVERSITY OF NATURAL MEDICINE. APPLICATION MATERIALS BECOME THE PERMANENT PROPERTY OF THE UNIVERSITY OF NATURAL MEDICINE. I ACKNOWLEDGE THAT THE APPLICATION FEE IS NON-REFUNDABLE.
Signature of Applicant______________________________ Date__________________
Thank you for submitting your application to the University of Natural Medicine.
The University does not discriminate on the basis of gender, religion, race, age, color, natural origin, sexual orientation, political affiliation or physical impairment for admission to any program or activity.
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