Application for Admission to Advanced Program

424 E Simpson St., Unit A
Lafayette, CO 80026
info@clinicalherbalism.com

Phone

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

Legal Name(Required)

First Last

Nickname or Preferred

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)

What month and year did you graduate from the Fundamentals Program?(Required)

Program you are applying for:(Required)

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 have officially applied to the CSCH Advanced Program. We will be in touch with you within a week from receipt of your application.

Date(Required)