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                                            Online Application for Admission

Thank you for your interest in our program.  Please use this form to complete an online gnereal application for admission.  You will need to mail or have mailed all other required supplemental documents which can be found here along with the application fee to:
Office of Admissions
Dragon Rises College of Oriental Medicine
1000 NE 16th Ave.  Bldg. F.
Gainesville, FL  32601

Dragon Rises College of Oriental Medicine admits qualified students of any race, color, gender, sexuality, national and ethnic origin.  The college does not discriminate on the basis of race, color, gender, sexuality, national or ethnic origin in administration of its educational policies, admissions policies or other school-administered programs.
First Name:
Last Name:
Social Security #:  
Email Address:  
Current Postal Address:  
City:  
State/Province:  
Country:  
Zip/Postal Code:  
Telephone: ()-
 
Date of Birth:  
Place of Birth:  
Country of Citizenship:  
If not US citizen,
Visa # and exp. date:
 
Other last names you have used on official documents:
 
Permanent Address & Phone (if different from above):
 
Closest Relative
(Name, Address, Phone, Relationship):
 
Person to contact in case of emergency  (Name, Address, Phone, Relationship):
 
Employer Info
(Name, Address, Phone, Email):
 
Have you ever been convicted
of a felony?

If yes, please explain.


 
List first academic institution you  attended with dates, degree date, or credit hours accumulated:

 
List second academic institution you attended with dates, degree date, or credit hours accumulated:


 
List third academic institution you attended with dates, degree date, or credit hours accumulated:


 
List fourth academic institution you attended with dates, degree date, or credit hours accumulated:


 
List fifth academic institution you  attended with dates, degree date, or credit hours accumulated:

 

Names and addresses (postal and email), phone #'s of two personal references (not family):

First reference:       

Second reference:   

How did you hear about Dragon Rises College?

Have you visited Dragon Rises College? 

Have you explored our web site? 

Please provide relevant biographical information.  This should be brief, including your basic philosophy of health care and how you became interested in pursuing a course of study in the field of acupuncture and oriental medicine.

Several paragraphs are expected.  The box will expand as you type.

I certify that the information provided on this application is complete and accurate to the best of my knowledge, and that Dragon Rises College of Oriental Medicine is authorized to make whatever inquiries are necessary to certify the accuracy of my records. I understand that withholding or giving false information will make me ineligible for admission or result in dismissal from Dragon Rises College of Oriental Medicine.

Please type your name and date in the boxes below to signify your electronic signature. 

        
Name                                               Date

Click the Submit button to send.  We'll contact you as soon as we receive your application.  Remember that this is the general application form and all supplemental forms must be completed and returned as part of the admissions process.  These forms can be found by clicking on "here" at the top of the page.  Congratulations on beginning your journey to become an Oriental Medicine practitioner!!