Application for Admission to Advanced Program

424 E Simpson St., Unit A
Lafayette, CO 80026
720-406-8609
apply@clinicalherbalism.com

There is a $50 application fee that is non-refundable.

Legal Name(Required)

First Last

Name you go by:

First Last

Local Address(Required)

Street Address City State ZIP Code

Permanent Address, if different

Street Address City State ZIP Code

Phone(Required)

Email(Required)

Social Security Number(Required)

Please note a social security number is required for enrollment by the state of Colorado regulations. This is a secure website. Your information is not stored in the database.

What year and Fundamentals Program (Day/Eve) did you complete at CSCH?(Required)

What Program Are Applying For(Required)

Advanced DAY

Advanced EVENING

How did you hear about CSCH?

Required (Submit with this application form.)

Please write and attach a one-page essay describing why you want to attend the Advanced Herbalism Certification Program at CSCH.

Please sign and upload documents below.

Upload Documents(Required)

Drop files here or

Max. file size: 50 MB, Max. files: 4.

To sign type your name below

By entering your name above, you officially apply to the Colorado School of Clinical Herbalism

Date(Required)

Application Payment - $50

Application Fee

Price:

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Billing Address(Required)

Street Address City State ZIP Code

Name

This field is for validation purposes and should be left unchanged.

Application for Admission to Advanced Program

Please sign and upload documents below.

Application Payment - $50

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