CANADIAN INSTITUTE OF NATURAL HEALTH AND AYURVEDA
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front face up to shoulder
Student # Registration and Admission Form (Please Print)
Name of the Student_______________________________
Permanent Address________________________________,
City_______________________, Province/State_________________,
Zip/postal code____________
Email Address_______________________, Web site_________________________
Education: (Basic and professional education)
Name of the school
Year graduated
Courses/Subjects
Certificate Diplomas/Degree obtained
Work Experience Employed/self employed where?
Period worked
Accountabilities/Duties
Association’s memberships:
Association Name
Position held
Member since
The above information is correct and true to my knowledge.
Date Signature
Student pays Registration fees ($157.50) during registration and admission.
Work Experience:
Employed/self employed where?
Period worked
Accountabilities/Duties
Association’s memberships:
Association Name
Position held
Member since
The above information is correct and true to my knowledge.
Date Signature
Affix a recent photo here with
front face up to shoulder
Student # Registration and Admission Form (Please Print)
Name of the Student_______________________________
Permanent Address________________________________,
City_______________________, Province/State_________________,
Zip/postal code____________
Email Address_______________________, Web site_________________________
Education: (Basic and professional education)
Name of the school
Year graduated
Courses/Subjects
Certificate Diplomas/Degree obtained
Work Experience Employed/self employed where?
Period worked
Accountabilities/Duties
Association’s memberships:
Association Name
Position held
Member since
The above information is correct and true to my knowledge.
Date Signature
Student pays Registration fees ($157.50) during registration and admission.
Work Experience:
Employed/self employed where?
Period worked
Accountabilities/Duties
Association’s memberships:
Association Name
Position held
Member since
The above information is correct and true to my knowledge.
Date Signature
