DTCM/DAc Bridge Admission Application

Application Checklist
All Applicants

To be considered for admission for Five Branches University's Online DTCM/DAc Bridge program, your application package must include the following items:

1. Application for Admission (fully completed)
2. Recent passport-style photograph
3. Resume
4. Application fee of $100 payable by Visa, Mastercard, Discover, or American Express.
5. Proof of your acupuncturist license, if you have one.

Supporting Documents - sent separately

1. Official TCM or Acupuncture program transcript(s) from the college(s) where you received your Master's Degree
2. Official undergraduate transcript(s) showing at least 90 semester (or 135 quarter) credits.

3. Statement of Purpose
4. Letter of Reference
International Applicants

1. A photocopy of your government-issued ID card (also of dependents, if applicable)
2. Transcript evaluation by WES (https://www.wes.org)
3. Test of English as a Foreign Language (TOFEL) or International English Language Testing System (IE:TS) scores

Application for Admission
Online DTCM/DAc Bridge Program
Admission Information
I am applying for*

Spring 2025Summer 2025Fall 2025
I am applying for admission to*

Online DTCM Bridge program (only for those with a Masters in Traditional Chinese Medicine)Online DAc Bridge Program (only for those with a Masters in Acupuncture)
Student type*

U.S. CitizenInternational
Personal Data
Name*

First NameMiddle NameLast Name
Name on previous academic record (If different from above)

First NameMiddle NameLast Name
Preferred Name
Photo*

Please include one recent photo of yourself (passport-style) (jpg, jpeg, png file available)
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Present Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Date of Birth (MM/DD/YY)*

MonthDayYear
Date
Email*
example@example.com
Acupuncturist License(s), if any
State issued
License Number
State issued
License Number
State issued
License Number
Personal Information

For U.S. Government statistical reports purposes only
Gender*

FemaleMaleOther
Race*

American Indian, Alaskan NativeHispanicBlack Non-HispanicWhite Non-HispanicAsian or Pacific IslanderOther
Social Security Number (Mandatory for US citizens and residents)
International Students
Country of Citizenship
Country of Birth
TOEFL

YesNo
TOEFL Score
TOEFL Date

MonthDayYear
Date
IELTS

YesNo
IELTS Score
IELTS Date

MonthDayYear
Date
Education: TCM or Acupuncture College/University
Name of TCM or Acupuncture College/University*
Degree awarded or equivalency*
Additional TCM/Acupuncture College/University names and degrees awarded
Education: Undergraduate College/University
Name of Undergraduate College/University*
Degree awarded or equivalency*
Additional undergraduate College/University names and degrees awarded
In Case of Emergency, Notify
First Contact Name*
First Contact Relationship*
First Contact Phone*
Please enter a valid phone number.
First Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Second Contact Name*
Second Contact Relationship*
Second Contact Phone*
Please enter a valid phone number.
Second Contact Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Resume

(pdf, doc, docx, jpg, jpeg, png file available)
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Photocopy of your government-issued ID card

(pdf, doc, docx, jpg, jpeg, png file available)
Cancelof
Statement of Purpose

(pdf, doc, docx, jpg, jpeg, png file available)
Cancelof
Letter of Reference

(pdf, doc, docx, jpg, jpeg, png file available)
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How did you first hear about Five Branches University's DTCM/DAc Bridge program?
Signature

I hereby certify that all information provided in my application package are accurate and true, and that I am the author of the attached Statement of Purpose.
Electronic signature*

Checking this box and entering my full name and date below constitutes my signature for all legal purposes.
First and Last name*
Legal name
Today's Date*

MonthDayYear
Application Fee*
prevnext( X )
Application Fee
$100 Quantity

Total

$0.00

Pay with Credit Card

Should be Empty:

Application Checklist

Admission Information

Personal Data

Acupuncturist License(s), if any

Personal Information

International Students

Education: TCM or Acupuncture College/University

Education: Undergraduate College/University

In Case of Emergency, Notify

Signature