Application Form

Name: *

Phone number: *

Either cell phone, home or workphone - list the phone you would like us to call, please

Email: *

The email that will be used for all communication and Virtual Campus Access

Preferred method of contact: *

I would like to be contacted by phone

I would like to be contacted by email

Other:

Please select how you would prefer to be contacted

Driver's license number:

Optional

Address
Where you would like the Enrollment Packet and Course Materials sent:

Country:

Previous Education and Experience:

Please choose previous education or current profession. Please note that we can transfer some of these hours in our AHE programs.

Course you are interested in applying for: *

Block 1 Foundation Module - 100 Hrs

Ayurveda Nutrition (150 Hrs)

Ayurveda Herbology (200 Hrs)

Ayurveda Panchakarma (150 Hours)

Ayurveda Workshops and short Programs

Ayurveda Health Educator (350 Hrs)

Ayurveda Wellness Practitioner (500 Hrs)

Other:

Please select the course you are interested in

Preferred method of payment: *

I would like to pay the Block 1 in advance for a discount = $600 (+$45 for materials)

I would like to pay the Block 1 in flexible payment plan of $210 x 4 (Payable in 16 weeks from time of enrollment)

I would like to pay the Block 2 AHE or AWP 500 Hr in advance for a discount of 10%, as well as early bird discounted rate

I would like previous Ayurveda CE's from another Insitute, at the rate of $1 per Credit Hour for AHE and AWP courses

I would like to pay my BLOCK 2 Course (AHE, AWP, Nutrition or AHRB) by installments

I would like to just submit my application at this time and will make payment arrangements later

Other:

Do you have a high school diploma?: *

Yes

No

Highest Education Completed: *

What is your aim and objective in studying Ayurveda?:

Please note that we accept only 15 candidates for advanced courses. Your answer can help you get priority in a waiting list. This is not applicable to the Foundation courses.

Agreement - please read carefully
By agreeing to this, I understand that if I am selected and choose flexible payment options, I may need to submit my credit card information in advance (by phone or website), and my credit card will be charged on the first day of enrollment, by the 15th of every month, as well as the last day of enrollment whatever comes first. There are no refunds for flexible payment option plan. I understand that I need a good Internet connexion, with latest browser. (And, connexion from Internet cafe and workplace are not supported). I have understood that if I decide to unenroll, and, and, have paid the full payment - my refund will be pro-rated at $25 per class accessed, along with course material, handling, shipping and processing fees for a sum of $249 per module. I understand that Ayurveda is a complimentary health system, not meant to cure, diagnose or treat any disease. All the information in this course is for 'informational' purpose and the knowledge of herbs, panchakarma or nutrition I may learn is not recognized by FDA. I understand that I must complete Block 1 course and graduate with 65% scores minimum, before I move on to Ayurveda Wellness Practitioner or 50% minimum for Ayurveda Health Educator Program. I understand that the college is not responsible for me, or, any job opportunities. I understand that this is an online, virtual course with no physical classes. The college does not accept any federal aid, nor gives out any scholarships

(response required): *

I agree

I don't agree

E-Signature: *

Please sign this application by entering your initials here

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