Application Form

• Select Program: *

  Foundation Course   Advance Course

• Name: *

• Email: *

• Address: *

• City: *

• Zip: *

• State: *

• Primary Phone: *

• Secondary Phone

• Date of Birth *

• Occupation: *

• Preferred days and times you can be available for a phone interview *

• 1. How did you hear about the School of Traditional Western Herbalism? *

• 2. Please describe your background, if any, in herbal medicine or related natural healing practices (eg. flower essences, homeopathy, massage etc). *

• 3. Please tell us about your interest in this course and what you hope to accomplish through your herbal studies. *

• 4. Do you have any medical training? (RN, OMD, EMT, ND, DC, etc.). *

• 5. This course involves a 9-month (time and financial) commitment of 1 weekend (2.5 days) per month. Are there any situations (school, career, family, health, etc.) that could prevent you from making this commitment? (See registration guidelines on the website for details).

  Yes   No

• Please explain if you have concerns:

• 6. In addition to class time there will be supplemental reading, diagnostics practice and informal assignments to complete between classes. Are you able to allocate time for such assignments throughout the course? *

  Yes   No

• Please explain if you have concerns:

• 7. Do you have any health related needs that we will need to be aware of? *

  Yes   No

• Please explain if you have concerns:

• 8. I have reviewed and fully understand the tuition guidelines and registration process outlined on the website. *

  Yes   No

• Tuition and Registration Questions:

• Any additional comments or questions