Application for Admission to Clinical Program

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

There is a non-refundable $50 Application Fee per Program.

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 did you complete Advanced Herbalism at CSCH?(Required)

What Program(s) Are You Applying For?(Required)

Clinical Program

Nutrition Program

Flower Essences Program

Application Fee is $50 per Program. If you are applying to Flower Essence ONLY, OR you are a past Clinic Graduate applying to Nutrition ONLY there is a $100 extra staff fee. This fee will be applied to your Enrollment Agreement.

Required (Submit with this application form.)

Please write and attach a one-page essay describing why you want to enroll in the Clinical 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)

Submit Payment Below to Complete the Application Process.

Application Payment is $50 per Program applied to.

Price:

Example: If you are applying for 2 Programs (above), select "Two Programs" and your fee is $100.

How many Programs are you applying for?(Required)

One Program

Two Programs

Three Programs

Total

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

Comments

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

Application for Admission to Clinical Program

Please sign and upload documents below.

Submit Payment Below to Complete the Application Process.

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