Certificate in Chinese Herbal Medicine application form - new Step 1 of 3 33% Your Personal InformationYour Name(Required) First Last Your Email Address(Required) Enter Email Confirm Email Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Your Phone(Required)Academic Year You Are Applying For(Required) Date of Birth(Required) Social Security Number(Required) In Case of Emergency, Notify:First Name, Last Name(Required) Relationship(Required) Email Phone(Required) Address Ethnic Information (for statistical information only)(Required)African American/Black, Asian, American Indian/Alaska Native, Hispanic/Latino, Native Hawaiian/Pacific Islander, White, Two or more races, or Ethnicity Unknown Are you currently practicing Chinese medicine? (yes/no) If yes, provide practice name and location. How do you plan to pay for tuition? Savings Employment Parent or Family Member Vocational Rehabilitation Federal Financial Aid Please list all colleges/universities classes, beginning with the most recent.Name of Institution(Required) Location(Required) Degree Sought(Required) Date Started(Required) Date Finished(Required) Did you graduate? (Yes/No)(Required) If no degree was awarded, please indicate the approximate number of credits earned Other Degree or EducationName of Institution Location Degree Sought Date Started Date Finished Did you graduate? (Yes/No) If no degree was awarded, please indicate the approximate number of credits earned Describe any additional degrees or education hereHow did you hear about the Certificate in Chinese Herbal Medicine program? Have you ever had a license, certificate, or credential revoked or suspended?* (Yes/No)(Required) If so, please explain the details hereHave you ever been convicted of a felony? (Yes/No)(Required) If so, please explain the details hereEnglish Language Competency (All applicants must demonstrate English language competency)Which of the following have you completed? four years at a U.S. high school demonstrably delivered in English; at least two years (60 semester/90 quarter credits) of undergraduate or graduate-level education in an institution accredited by an agency recognized by the U.S. Secretary of Education; at least two years (60 semester/90 quarter credits) of undergraduate or graduate-level education demonstrably delivered in English; high school or two years (60 semester/90 quarter credits) of undergraduate- or graduate level education in an institution in one of the following countries or territories: American Samoa; Anguilla; Antigua & Barbuda; Australia; Bahamas; Barbados; Belize; Bermuda; Botswana; British Virgin Islands; Cameroon; Canada (except Quebec); Cayman Islands; Christmas Island; Cook Islands; Dominica; Federated States of Micronesia; Fiji; The Gambia; Ghana; Gibraltar; Grenada; Guam; Guyana; Ireland; Isle of Man; Jamaica; Kenya; Lesotho; Liberia; Malawi; Montserrat; Namibia; New Zealand; Nigeria; Norfolk Island; Papua New Guinea; Philippines; Pitcairn Islands; Sierra Leone; Singapore; South Africa; South Sudan; St. Helena; St. Kitts & Nevis; St. Lucia; St. Vincent & the Grenadines; Swaziland; Tanzania; Trinidad and Tobago; Turks and Caicos Islands; United Kingdom; U.S. Virgin Islands; Uganda; Zambia; Zimbabwe. Do you speak English fluently? (Yes/No) If no, please indicate if you have completed one of the following:* Test of English as a Foreign Language (TOEFL) International English Language Test (IELTS) China Standard of English Language (CSE) Common European Framework Ref (CEFR) Cambridge First Certificate in English (FCE) Duolingo English Test Cambridge English Advanced (CAE) Occupational English Test (OET) Attachments700-1000 Word Essay: Why do you want to study Chinese herbal medicine? How do you see the addition of herbal medicine enhancing your ability to help your patients?Upload your essay in .pdf, .doc or .docx formatAccepted file types: pdf, doc, docx, jpg, jpeg, Max. file size: 25 MB.Selfie/HeadshotUpload your resume in jpeg, jpg, gif, png, pdf formatAccepted file types: jpeg, gif, png, pdf, jpg, Max. file size: 25 MB.Copy of valid photo identification (driver's license preferred)*Upload your resume in jpeg, jpg, gif, png, pdf formatAccepted file types: jpeg, gif, png, pdf, jpg, Max. file size: 25 MB.Photocopy of current acupuncture license (if applicable)Upload your resume in jpeg, jpg, gif, png, pdf, doc, docx formatAccepted file types: jpeg, jpg, gif, png, pdf, doc, docx, Max. file size: 25 MB.Photocopy of your current NCCAOM certification (if applicable)Upload your resume in jpeg, jpg, gif, png, pdf, doc, docx formatAccepted file types: jpeg, jpg, gif, png, pdf, doc, docx, Max. file size: 25 MB.English Language Competency Exam scoresUpload your resume in .pdf, .jpg, .jpg, .doc or .docx formatAccepted file types: pdf, doc, docx, jpg, jpeg, Max. file size: 25 MB.Immunization RecordsUpload your resume in .pdf, .doc or .docx formatAccepted file types: pdf, doc, docx, Max. file size: 25 MB.Non-digital submissionsOfficial college and ACAHM accredited transcripts mailed directly to Daoist Traditions from the institution.Official College Transcripts of your highest post secondary degree showing at least 60 semester credits/90 quarter units of general education at the baccalaureate level from a college/university accredited by an agency recognized by the U.S. Secretary of Education. Must be mailed directly to Daoist Traditions from the Institution or official electronic transcripts emailed to admissions@daoisttraditions.edu from the Institution. Official transcripts showing completion of, or current enrollment in, an ACAHM accredited/pre-accredited masters level acupuncture program. Must be mailed directly to Daoist Traditions from the Institution or official electronic transcripts emailed to admissions@daoisttraditions.edu from the Institution.Letter of reference from a professional contact, ie: employer/teacher, mailed directly to Daoist Traditions.*Letter of Reference must be mailed directly to the college at 382 Montford Ave, Asheville NC 28801 or emailed to admissions@daoisttraditions.edu .I waive my right to access/view this letter of reference. I waive my right ConfirmationBy checking this box you certify that all information provided is accurate and complete. Any misrepresentation may be grounds for dismissal.* I certify and agree Applications Fee Price: Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name