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Online Application for Admission

Thank you for your interest in our program.  Please use this form to complete an online application for admission.  You will need to mail all other required documents and the application fee to us at:

Office of Admissions
Dragon Rises College of Oriental Medicine
1000 NE 16th Ave.  Bldg. F.
Gainesville, FL  32601

Dragon Rises 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 statement and information I have provided on this application are correct and complete. 

Please type your name in the box below to signify your electronic signature.  Please indicate the date in the appropriate box as well.

        
Name                                               Date

Click the Submit button to send.  We'll contact you as soon as we receive your application.  Congratulations on beginning your journey to become an Oriental Medicine practitioner!!