Rockwell Admissions Applications

1
Name* This field is required.
First Name
Last Name
2
Email Address* This field is required.
3
Age* This field is required.
4
Birth Date* This field is required.
Month
Day
Year
5
Country of Origin/Nationality* This field is required.
Select Country
United States
Afghanistan
Albania
Algeria
American Samoa
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaidjan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia, Kingdom of
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
Former Czechoslovakia
Former USSR
France
France (European Territory)
French Guyana
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Great Britain
Greece
Greenland
Grenada
Guadeloupe (French)
Guam (USA)
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast (Cote D'Ivoire)
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyz Republic (Kyrgyzstan)
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique (French)
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldavia
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
Neutral Zone
New Caledonia (French)
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Polynesia (French)
Portugal
Puerto Rico
Qatar
Reunion (French)
Romania
Russian Federation
Rwanda
S. Georgia & S. Sandwich Isls.
Saint Helena
Saint Kitts & Nevis Anguilla
Saint Lucia
Saint Pierre and Miquelon
Saint Tome (Sao Tome) and Principe
Saint Vincent & Grenadines
Samoa
San Marino
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syria
Tadjikistan
Taiwan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
USA Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (USA)
Wallis and Futuna Islands
Western Sahara
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
6
Current Address* This field is required.
7
Preferred Contact Number* This field is required.
Area Code
Phone Number
8
Which of the following methods do you preferred to be contacted by? Please choose all that apply:* This field is required.
Text
Phone
Email
9
How did you hear about Rockwell?* This field is required.
Google
Facebook
Instagram
Friend
Twitter
Pinterest
YouTube
FB Ad
IG Ad
10
What other holistic medicine schools have you considered or attended in the past, and were you satisfied with the cost of the program and the education you received?* This field is required.If none, you may write N/A.
Small
Normal
Large
Huge
Ok
Ok
11
What is your desired program of study? * This field is required.
12
Did you read (and are you familiar with) the entire program FAQ, curriculum, required textbook checklists, and modules for your specific program?* This field is required.
YesNo, not yet, but I will later.
13
What made you choose Rockwell and what do you look most forward to learning? What is your personal story and what do you dream of doing once your earn your holistic medicine doctorate(s)?* This field is required.
Small
Normal
Large
Huge
Ok
Ok
14
Do you currently subscribe to any specific dietary protocol or lifestyle? Please tell us more below.* This field is required.vegan, vegetarian, traditional diets, WAPS, paleo, GAPS, FODMAPS, zero carb, keto, vegetarian keto, lipid diet, 80/20, low-carb, AIP, SCD, pescetarian, Gerson, raw food, whole food, none, etc.
15
If you are vegetarian or vegan, please confirm your understanding that we teach our students about all traditional and therapeutic diets, including autoimmune paleo (AIP) and Weston A. Price (WAP).* This field is required.
Yes, I understand.No, exit application..
16
You understand and can explain the difference between a traditional naturopath and a licensed naturopathic physician?* This field is required.If you are NOT applying for Traditional Naturopathy/Certified Holistic Health Practitioner or the Rockwell Tri-Doctorate, please click N/A or not applicable.
Yes
No
Still not sure.
Not applicable to the program I am applying for.
17
In your own words, what is the difference between a licensed naturopathic physician and a traditional naturopath?* This field is required.The answer is not "one is licensed and one is traditional". Please go into detail so we know you understand your rights and responsibilities if getting the RTD or TND. If you are NOT applying for either of those programs, and you are only applying for the CHD or AHND, then type N/A.
18
Please Note:
19
Please confirm your understanding and agreement with the above statement.* This field is required.
Yes, I understand and agree.No
20
Are you in the military, a veteran, or spouse or child of an active duty, deceased, or living veteran? * This field is required.
21
Which tuition plan is right for you?* This field is required.
3-Year Tuition Payment Plan
2-Year Tuition Payment Plan
1.5-Year Tuition Payment Plan
1-Year Tuition Payment Plan
One-Time Tuition Payment
None of the Above, I'm Applying For Scholarship.
22
Which scholarship class do you fall under?If you are applying for an income-based scholarship plan, we strongly encourage you to choose a realistic tier you can actually afford for the long-term. If we require any kind of verification, we will notify you in your admissions response letter. Please note, you can cancel your tuition payments at any time, however we do not offer refunds to students on scholarship. All scholarships include the full RTD, or you can just complete the specific programs of your choice within the RTD.
Class A $20 per month / 36 months
Class B $30 per month / 36 months
Class C $40 per month / 36 months
Class D $50 per month / 36 months
Class E $60 per month / 36 months
Class F $75 per month / 36 months
None of the above. I am paying regular tuition.
23
Other than traffic offenses, have you ever been convicted of any misdemeanor, felony, or other crime or arrested, regardless of age? If you answered yes to either question, please provide an explanation and the approximate dates of each incident.* This field is required.This must be truthful and accurate or you risk losing your Rockwell Scholarship and/or ID after graduation. We respect honesty but must have this information in order to protect the school and make sure people are practicing ethically with our standards.
Small
Normal
Large
Huge
Ok
Ok
24
What is your preferred start date? * This field is required.
Date
Year
Month
Day
Date
25
Please note, we are dedicated to processing applications quickly. If applicants do not enroll on their requested start date and/or do not notify us of a new one BEFORE it expires, then their application will be closed.* This field is required.Out of respect for our institution and the Rockwell Committee on Admissions, please confirm that if accepted, you will enroll on your requested start date and/or notify us of a new one before it expires via email. All students must enroll within 30-days of their completed application.
Yes, I understand and agree to the terms.No, exit the application.
26
READ & ACKNOWLEDGE: If you ever need to unenroll/stop payment, we request that you contact our office at least 10 days before your next tuition payment, or unenrollment will take place the following month.* This field is required.
Yes, I understand.
27
Your signature below confirms that all of the information in this application is factually true, honestly presented, and that you are the person submitting this application.* This field is required.Spam Protection & Authenticity Verification
Yes, all of the information is true and I am the person I say I am.
28
Signature* This field is required.Signature of applicant ID
Clear
29
♡ We will respond to your application within 1-3 business days. If you do not recieve a response within 4 days, please be sure to check your spam mail and/or drop us a line so we can check on the status of your application. Thank you kindly! ♡
30
Rockwell Student Application Fee* This field is required.Students paying regular tuition are eligible for a refund in their first 14-days after enrolling. Scholarship students are not eligible for refunds due to the extremely low cost for the programs they are paying.
My Bag
1
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
Total costUSD
Rockwell Application Fee
undefined
$27.00+
Back
Total $0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
2020
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
Expiration Year
31
Tags
[object Object]
Should be Empty:

Save your progress

Save your progress

Your form submission has been saved as a draft.

Save your progress

Your form submission has been saved as a draft.