The Academy of Healing Arts

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Application for Admission to Academy of Healing Arts

Thank you for deciding to apply to our school. We ask that you provide us with a little information about yourself, so we may get you started right away. Please answer all the questions completely.You may submit it electronically, or print it and bring it in with you.

Preffix:
First Name:
Middle Initial:
Last Name :
Suffix:
Social Security #
Birth Date	(xx/xx/xxxx) (month/day/year)
Driver's Licence # & State	,
Address:
City:
State:
Zip Code
Email Address
Day Phone
Evening Phone
Program you are applying for
Last High School Attended
City and State	,
Did you graduate		Year Graduated
College or Vocatonal school attended & State	,
Years Attended	to
College or Vocatonal school attended & State	,
College or Vocatonal school attended & State	to
What type of transportation do you use?	List Other:
Are you currently employed?
Do you have any Medical conditions or physical handicap which would constitute either an occupatonal lilmitation or a Limitation to participate in the program
Have you eve been arrested? If yes, please explain.
How did you hear about us?
If other, please specify:
Comments: (if you are interested in more than one program please indicate it here). Thank You	(250 Character Limit)