First Name Last Name:
Home Address
Apt#:
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Country:
Phone:
E-Mail:
HIGH SCHOOL (or equivalent) Name:
Address:
Date of Completion:
COLLEGE (last attended) Name:
Address
Highest Degree and Major:
Graduate?
OTHER EDUCATION: (Please list all other educational achievements including correspondence courses, vocational training, seminars, workshops, etc. Please Note: All types of formal education must be verified in writing, i.e., Transcripts or Diploma. Attach an additional sheet, if necessary:
OTHER EXPERIENCES: Independent study, military, career experiences related to the health field:
STUDY INTENT Doctor of Naturopathy in Original Medicine (DNOM) Master of Science in Original Medicine (MSOM) Bachelor of Science in Original Medicine (BSOM) Certified Nutritional Counselor Certified Herbalist in Original Medicine Certified Medical Missionary Individual Course
If Individual IIOM course was selected:
The IIOM one-time registration fee of $25.00 must be paid in full at the time of submission of the IIOM Application Form. Students may elect to pay for individual courses, one at a time, when working towards completion of a certificate program or degree program. Tuition must be paid in full before receiving coursework. IIOM also offers tuition installment payment plans. a.TUITION REFUND POLICY: No refunds are given subsequent to 10 days after enrollment. IIOM mailing address is: IIOM P.O.Box 506 Smithfield, VA 23431
Please call our Enrollment Department if you have any questions - (410) 884-9319
