APPLICATION FORM

TRADITIONAL CHINESE VETERINARY MEDICINE

AND

VETERINARY ACUPUNCTURE / HERBOLOGY CERTIFICATION PROGRAM

Name:  ________________________________

Degree (please circle one): DVM, VMD

Address: ______________________________

       ______________________________

       ______________________________

Phone number:  _________________________

Fax number:  ___________________________

Email (required): _________________________________

Emergency phone number (will be kept private): _______________

• Admissions requirements: Professionals registering from the North American continent must have graduated from an American Veterinary Medical Association (AVMA) accredited Veterinary Medical School
• Professionals registering from outside the North American continent please provide copy of the pertinent Visa, Diploma and proper governmental licensure of the country that you are currently practicing
• Two character reference letters, one from a non-family member and one from an employer
• Two passport photos
• Include a copy of the state license or the registration papers that your state agency has issued in accordance with their regulations and bylaws
• Include a letter stating that you have read and understand your state / province Veterinary Medical Practice act and the definition(s) set forth by their Veterinary Licensing & Regulation office for Integrative / Complementary or Alternative Modalities
• Include a $600.00 dollar (USD, check must be drawn on a US Bank) deposit with the application form.  The remaining of tuition ($4,020.00) to be paid during the interview (total of $4,620.00). We apologize, but we are unable to accept foreign checks.
• ***Please note that a 2.1% charge will be added to all credit card transactions***

If you have any questions, please contact the Healing Oasis Wellness Center office at 262-878-9549; 262-886-6460FAX; howc@thehealingoasis.com

PLEASE MAIL THE REGISTRATION FORM TO:

Healing Oasis Wellness Center

2555 Wisconsin St; Sturtevant, WI  53177-1825

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