WPC) L>G7} i݅8C#I6"!^A&PWoEU!ߔwa)UIP9 [H/h.nZ|3\مFX`;s{2@'LՃXEN4ŀd\5sumA",!k6{֕ü: -{᪪C0x]F7qH8oc}HVw;k S Yb$(Km¸B9.aEA^ zOm :DsW㱛[J5C.([NeO&p[^3n>1J_7:Nth#v4UB1M9@3XWuf:'ӥ_Z9\~k yo$HU0 0  U>@ 0 ~U2 0 U, 0 0.t 0N 0h 0X 04r 0 U. 0 0: 0 0 0 0 0 0 0 0 0l 0Q 0; 0" 0 0 0 0 0x 0M 0 0x!A" 0# 0(# D+# AM#$^ p$w@|$|$|$U@$ 0$$$$$ 0%%%%%%& 0&#!L'U Nm( %(M(((N(4() m) $New York<yk:Default ParaS\  `&Times New RomanS  XXXE $New YorkE  \  `&Times New Roman4mk2Default XXXG%2A`HelveticaG  XXXE $New YorkE  %2A`Helvetica:gk8Default SS A $GenevaA  XXXE $New YorkE  $Geneva2''0Header      XXX .,Body 20Footer     64Footnote XXX<pn:Footnote IndG%2A`HelveticaG  XXXE $New YorkE  42COURIER 6\^4Courier 1C<6X9`(CourierC    E $New YorkE    <6X9`(Courier8OS6Body Text ,A $GenevaAE $New YorkE:8Default TB 2P+P 0_level1  X 8.v & ~.6>"823  ..  8.v & ~.6>"8  2M+P 0_level2   5+v vv & ~.6>"523  ..  8.v & ~.6>"8  2J+P 0_level3   2( & ~.6>"223  ..  8.v & ~.6>"8  2G+P 0_level4  ` /%& & & ~.6>"/23  ..  8.v & ~.6>"8  2D+P 0_level5   ,"~ ~~.6>",23  ..  8.v & ~.6>"8  2A+P 0_level6   ) .6>")23  ..  8.v & ~.6>"8  2>+P 0_level7  h &...6>"&23  ..  8.v & ~.6>"8  2;+P 0_level8   #6>"#23  ..  8.v & ~.6>"8  28+P 0_level9    6>" 23  ..  8.v & ~.6>"8  2PP 0_levnl1  X 8.v & ~.6>"823   8.v & ~.6>"8  2MP 0_levnl2   5+v vv & ~.6>"523   8.v & ~.6>"8  2JP 0_levnl3   2( & ~.6>"223   8.v & ~.6>"8  2GP 0_levnl4  ` /%& & & ~.6>"/23   8.v & ~.6>"8  2DP 0_levnl5   ,"~ ~~.6>",23   8.v & ~.6>"8  2AP 0_levnl6   ) .6>")23   8.v & ~.6>"8  2>P 0_levnl7  h &...6>"&23   8.v & ~.6>"8  2;P 0_levnl8   #6>"#23   8.v & ~.6>"8  28P 0_levnl9    6>" 23   8.v & ~.6>"8   %'..  @XfXX@XXXX@Xf  Ҁ(2$ >+!..  @XfXX@XXXX@Xf   ')..  @XfXX@XXXX@Xf  Ҁ(2$ >+!..  @XfXX@XXXX@Xf  ݁ Level 1 Level 2 Level 3 Level 4 Level 5(2$ >+!..  @XfXX@XXXX@Xf  ($'dxd()*+A<< cZ1, EDDE{(mK Z(Times New Roman (2$ >+!..  @XfXX@XXXX@Xf  (2$ >+!..  @XfXX@XXXX@Xf  3|x(+$..  @XXX@XX4XX@XHitachi DDS32 PostScript0(9 Z6Times New Roman Regular@XhO1U >+!..  @XfXX@XXXX@Xf  _    XXXX$&  K7v & ~.6>"$&F)XKӀ " T7v & ~.6>"$&F)X$&XT1XfXXXArizonaSchoolofAcupuncture      T7v & ~.6>"$&F)X$&XT \  andOrientalMedicine1X1Xf \݌  Ќ    1=1Pleaseattachpassport  sizephotohere   v   &  v T   1XfX1= APPLICATIONFORMASTERSPROGRAMADMISSION &     T7v & ~.6>"$&F)X$&XT Programintended:M.Ac.򀀀M.Ac.(Evening)򀀀M.Ac.O.M.񀀀ABTcert.񀀀Herb""!!񀀀!!""   Fulltime򀀀Parttime򀀀SS#򀀀񀀀񀀀   Pleaseprintortype:Lastname򀀀Firstname򀀀Middleinitial򀀀 x  Address򀀀 d City򀀀󀀀State򀀀Zip򀀀 rP Phone:Home(򀀀)򀀀Work(򀀀)򀀀Cell򀀀 ^< Emailaddress򀀀 J( DateofBirth v 򀀀 6 Male򀀀Female򀀀Age򀀀MaritalStatus򀀀 " Incaseofemergency,contact:򀀀  (Name)򀀀  (Address) v   &  ~    . (Phone)(Relationship)  Education:(Pleasestatenameifdifferentonschoolrecord)򀀀 ` 0  0v$$1X1XfName  &  ~ City/State .   DatesAttended    DegreenLv$v$ nLv$v$ HighSchool:񀀀񀀀_______________________________________________________________________ Z8    College(s):򀀀 2!" 򀀀  #$ HealingArts/HealthProfessionEducationandExperience(Useseparatesheetifnecessary.):̀ &#( 򀀀 (p%*   j*H',  Employment:Pleasebeginwithmostrecent.  NameofBusiness &  ~    . City/State   6   From/To D 1.򀀀 0 2.򀀀  3.򀀀  .*0   Haveyoueverbeentreatedforanymedicalorphysicalconditionsotherthancoldsorminorinjuriesinthelastfiveyears?Yes򀀀No򀀀.(IfYes,pleaseexplainonaseparatesheet.)  L  Haveyoueverbeenconvictedofafelonyormisdemeanorotherthanatrafficoffense,orhadtreatmentforamentaloremotionalillness?Yes򀀀󀀀No򀀀 h     (IfYes,pleaseexplainonaseparatesheet.)Howdoyouplantopayforyoureducation? ,  񀀀  򀀀  PleasearrangeforthefollowingdocumentstobesenttotheAdmissionsDirector:a)Officialtranscriptsfromschoolsyouhaveattended,maileddirectlyfromtheschools.  ,b)Lettersofreferencefromtwoprofessionalorbusinesspeople,notmembersoffamily,whoknowyouwell.c)Astatementfromaphysicianstatingthatyouareingoodhealthandphysicallyabletoenteryourintendedprofession.d)Aletterfromanacupuncturistindicatingthatyouhavehadatleasttwoacupuncturesessionsfromhim/herinthepastyear.e)A$100applicationfee,payabletotheArizonaSchoolofAcupunctureandOrientalMedicine.Add$50processingfeefortransferstudents.f)Atypedresume,outliningeducationalandprofessionaldevelopment.g)Ahandwrittenstatementofatleast350wordsgiving:  yourreasonsforstartingthiscourseofstudy  proofofyourunderstandingofthecommitmentoftime,moneyanddedicationneededtosucceedasagraduatestudentofAcupuncture  yourcareerplans "D # Theinformationgiveninthisapplicationiscorrecttothebestofmyknowledge. t$"% 򀀀 `%#&   Signature   R     Date L&#'  8'$( Makeacopyforyourselfandmailthisapplicationwiththeappropriatefeeto:  MaryHallGatzka,AdmissionsDirector +|)- K"  ArizonaSchoolofAcupunctureandOrientalMedicine4646E.Ft.LowellRoad,Suite104̀Tucson,AZ,85712 ,h*. (520)7950787ortollfree(877)3675624http://www.asaom.edu/ /,-1  /,-1