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I am applying to the following option (Check one)*Homeopathy 101 - Foundations and Home carePractitioner Certificate ProgramAdvanced Clinical StudiesPersonal InformationName* First Last GenderFemaleMaleBirth Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920BirthplaceCurrent Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Home Phone*Work PhoneCell PhoneEmail* Emergency Contact*Emergency Contact's Phone Number*Education and Related ExperiencePresent OccupationEducational LevelI have completed less than 60 semester credits/90 quarter college credits.I have completed at least 60 semester credits/90 quarter college credits.Graduated collegeYear Graduated College19381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020Highest Degree EarnedUpload a copy of your college transcriptAccepted file types: pdf, png, jpg, gif.You may also send a copy to HSI offices: HSI PO Box 19382 Boulder, CO 80308, USA For Practioner Certificate Program, satisfactory completion of two academic years at an accredited educational institution or equivalent experience.I have not completed the required college units but have equivalent experience.I have neither met the hours requirement nor do I have equivalent experience.***Email firstname.lastname@example.org or call (970) 485-4613.Experience replacing higher education hoursIf you haven't met the higher education credits prerequisite for the Practitioner Certificate program, please detail the experience you feel replaces that education and the number of semester or quarter credits you have completed. Successful completion of HSI 101 can be considered an equivalent experience. Highest Degree EarnedName of College or UniversityList other degrees/certifications or related job/life experiences.Check any of the following college-level courses you have successfully completed (not required for admission). Anatomy Physiology Human Pathology If you have attended homeopathic courses or classes, please list date and instructor/institution.List any experience you have had with homeopathic treatment I found HSI through: Friend/family Homeopathic Educational Services - Dana Ullman HSI email newsletter Phone book Bella Spark HSI graduate Web search HSI mailing Facebook or Twitter Other Type a short letter of intent describing the reason and motivation for studying homeopathy.* Advanced Clinical StudiesName of institution at which you completed 500 documented hours of homeopathic educationUpload a copy of your transcript from that institutionAccepted file types: pdf, png, jpg, gif.You may also send a copy to HSI offices: HSI PO Box 19382 Boulder, CO 80308, USA To transfer to HSI you will need to take the final test of the course prior to the course into which you're transferring (in other words, if you want to enroll in Advanced Clinical Studies you'll have to take the HSI Final Case Analysis test. If you want to transfer in at HSI 201 you would have to take the test for 102) and submit a case taken and analyzed by the applicant. Please read more about transferring on our Policies page, or contact email@example.com or (970) 685-4613 for more information, the cost of the test, the study guide and the format in which to submit your case study.PaymentFees Application Fee: $75.00 Pressing the submit button will take you to a paypal payment page. Upon payment, using a credit card or your paypal account, your application will be submitted to HSI. Payment method*PayPal (does NOT require a PayPal account)I will pay by pnoneCommentsThis field is for validation purposes and should be left unchanged.