APPLICATION FORM

DOCTOR OF HOMOEOPATHIC MEDICAL SCIENCE (DMS)
PROGRAM (Four-Year Full-Time)

Last Name_______________________________ First Name ___________________ Initials ___ ___

Birth Name or Other Names Used: ______________________________________________________

Address: _________________________________________ City: __________________________

Province: ________________________ Postal Code: _____________ Country ________________

Home Telephone________________ Business: _________________ Message: ________________

Fax _________________________ Email: _____________________________________________

Date of Birth ____________________ Sex: ___ M ___ F

Please return your application package with:

1. Completed application form signed and dated.
2. Resume (including relevant experience, two references, memberships and personal interests)
3. Transcript of Academic courses completed.
4. Sponsor form attached: Yes____ No ____ Application in process _____
5. Arrangements for a Preliminary Interview will be scheduled. ________________________

Signature_________________________ Date_______________

REGISTRATION & TUITION:

PAYMENT SCHEDULE: First Year Classes commence September 4, 2002.
Registration Fee: $ 550.00 is due with Application ($50.00 non refundable deposit)
First semester payment: $3,500.00 is due on or before August 1st, 2002
Second semester payment: $3,500.00 is due on or before December 6th, 2002
** GST will be added to all prices. Books and supplies extra.
METHOD OF PAYMENT: Bank Draft or Certified Cheque payable to: Dr. Nielsen's Homoeopathic Medical Education and Research Centre Inc. (or DNHMERCI)

 

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