DAc Registration Form FA 2025-26

Registration Form FA 2025-26

Doctor of Acupuncture
Student ID Number*
Student Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date

MonthDayYear
Gender
Student E-mail*
example@example.com
Mobile Number*
Please choose the subjects for registration .
Acupuncture Class Subjects

BIOM508 Western Medicine Review
Total Credits
Didactic Tuition
Clinical Internship Subjects

CLIN605 Clinical Internship V
Total Internship Hours
Internship Tuition
Additional Fees

Application FeeRegistration FeeClinic Fee(Internship V)Lab Coat FeeTranscript Evaluation FeeGraduation FeeCase Studies Evaluation Fee
Total Tuition and Fee
Signature*

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