Last Name:

First Name:

Middle Initial:

Social Security Number:
(if applicable)

Date of Birth:

   (Month/Day/Year)

Ethnic Origin:

   (HEW Statistics Only)

Address:

Apt #:

City:

State:

   Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Country:

Zip/Postal Code

Country Code:

   (if outside of USA)

Telephone:

E-mail:

Schools Attended:

List the school, city, state, major, degree and dates.

High School:

College:

University:

Other:

Please submit official transcripts from each of the above schools to be sent directly to Florida Vedic College. High School transcripts are not necessary for those applying to the Masters or Doctoral programs.

Check the Degree Program for which you are applying:

Associates Degree Program in Dhanvantari Ayurveda

Not interested in pursuing a degree only wish to take independent classes for personal development.

Why do you wish to take classes or pursue a degree with the Ayurvedic College?

Comments:

Financial Understanding:

I have carefully read the "Financial Information" in the college catalog, and I agree to abide by all the policies set forth therein.

Yes No

Application Fee:

In order to complete your application to Ayurvedic College you need to send in your application fee of $60.00.

If copying the form to send by fax or mail, Please include your check for $60.00 for the application fee.

All applications without application fee will not be reviewed for entrance to our College

By choosing "Submit Application" you authorize Ayurvedic College to draft your credit card for the amount shown on this form. You acknowledge that you are the owner or authorized signer on the credit card information entered in this form. Your order will be processed through electronic credit card deposit.. Please make sure you remember to write down that you paid by credit card the application fees.

NOTE: If you send application fee by check/mail : All NSF returned checks will be subject to a $25.00 processing fee.

I agree to abide by my best character if accepted as a student in Ayurvedic College

I do here certify to the best of my knowledge, all of the above answers and statements in this application are true, and give an accurate and adequate account of my background and beliefs.

To Authorize Please Type "I Agree" Here: