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TCM ACUPUNCTURE APPLICATION

Your Information

First Name*

Last Name*

Email Address*

Street Address, House number etc*

Landmark, Floor, c/o

City*

Country*

State/Province*

Zip/Postal Code*

+ 4

Emergency Contact (Name an Number) ✓ Valid

Do you require any special medical support or learning assistance for participation in the TCM Acupuncture Program?

What brings you joy?

What languages do you speak?

English French Spanish Other

If Other, list other language(s) you speak

List your hobbies.

Are you a Registered Therapist?

Yes No

Which of the following have you completed?

High School Graduate College/University Graduate Healthcare Professional Doctor Nurse RMT Physiotherapist Chiropractor Osteopath Mature Student Other

Share with us between 100-200 words why you want to take the TCM Program? Why study with IMAI? Your vision as an Acupuncturist and more.

Upload CV

Max number of files : 1

Max File Upload size of each file : 1 MB

Upload Passport Picture

Max number of files : 1

Max File Upload size of each file : 1 MB

Letter #1

Max number of files : 1

Max File Upload size of each file : 1 MB

Letter #2

Max number of files : 1

Max File Upload size of each file : 1 MB

Are you a Canadian Resident? If so, from what province?

If not, what country are you from?

Are you a Canadian citizen, Permanent resident, Landed Immigrant or International Student?

Please list your professional credentials.

Please list expertise in any other modality or field.

How many hours would you have to study per week?

Are you able to make the required payments each term?

What month and year are you able to begin the TCM Program?

(289) 260-2335

(289) 276-5557

imaieducation@gmail.com

5063 N Service Rd, Burlington, ON L7L 5H6, Canada