Enrollment Application

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The Toronto School of
Homeopathic Medicine

Application for Enrollment: Homeopathic Diploma and Fellowship Programs

Please note that all fields followed by an asterisk must be filled in.

First Name*
First Name*

Last Name*
Last Name*

E-mail Address*
E-mail Address*

Street Address*
Street Address*

City*
City*

State/Prov*
State/Prov*

Zip/Postal Code*
Zip/Postal Code*

Country*
Country*

Home Phone*
Home Phone*

Business Phone

Fax

Web Site URL

Date of Birth: (MM/DD/YY)*
Date of Birth: (MM/DD/YY)*

Present Occupation:

Please indicate the program you are applying for:*
Please indicate the program you are applying for:*

	Toronto
	Distance-learning

If you have previously applied to our program, please state the academic year (e.g. 2008-2009):

If you are applying for advanced standing, please state the year you wish to enter (e.g. year 2 or 3):

Where did you hear of the course?

Please enter the word that you see below.

Forthcoming:

Registrar's Office: 1881 Yonge Street, Suite 500,
Toronto, Ontario M4S 3C4
Tel: (416) 966-2350
Toll-free: (800) 572-6001
e-mail: admin@homeopathy-canada.com
web site: www.homeopathy-canada.com

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The Toronto School ofHomeopathic Medicine

The Toronto School of
Homeopathic Medicine