MAIL APPLICATION TO:  Yamuni Institute of Healing Arts
Attn: Registrar USA office
P.O. Box 760
Maurice, LA 70555

(CLEARLY PRINT OR TYPE BELOW)

NAME:____________________________________________________________DATE:__________
ADDRESS:_________________________________________________________________________
CITY:__________________________________________STATE:_________________ZIP:________
HOME PH:(_______)____________________________________WORK PH: (_______)__________
EMAIL:____________________________________________________________________________
DATE OF BIRTH:___________________________SSN OR NAT. I.D.:______________________
BIRTHPLACE:________________________________CITIZEN OF:__________________________
SEX:____FEMALE____MALE               EVER CONVICTED OF A FELONY____YES____NO
PHYSICAL/MENTAL DISABILITIES____YES____NO.  IF YES, PLEASE EXPLAIN BELOW:
___________________________________________________________________________________
___________________________________________________________________________________
PROGRAM YOU ARE APPLYING FOR:________________________________________________
PREVIOUS EDUCATION/TRAINING:_________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
CURRENT OCCUPATION:___________________________________________________________
STATE WHERE YOU PLAN TO PRACTICE:___________________________________________
SIGNATURE:_______________________________________________________________________

IMPORTANT:

Submit: Completed & Signed application form
Provide Four (4) PASSPORT PHOTOS
Provide copies of all transcripts and CV(curriculum vitae)-BIODATA
Tuition, and or scholarship IF APPLICABLE, will be assessed after the application is accepted, assessment will be made on education, training, etc.
Method of Payment: Check, Cashiers Check or Money Order
(NO CREDIT CARDS ACCEPTED)
$50.00 U.S.D. APPLICATION FEE (NON REFUNDABLE)
A letter will be mailed to you specifying tuition amount and requirements
WITHDRAWAL/REFUND WITHIN THIRTY (30) DAYS FROM THE DATE OF REGISTRATION, all tuition except $50.00 USD application and assessment fee, will be refunded.
After thirty-one (31) days from the date of registration, there will be NO REFUND.