Homeopathic College of Canada
Postgraduate Masters of Homeopathy
Application for Admission

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Last Name First Name Middle Name
Dr. ___ Mr. ___ Ms. ___ Mrs. ____ E-mail: ____________________________
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Permanent Address (Street & Number) City
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Province/State Postal Code/Zip Code Country
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Home Telephone Business Telephone Fax
Status in Canada: Canadian Citizen: __ Perm. Resident: __ Student VISA: __ Not in Canada: __
Country of Origin: _____________________ Date of Birth: _______________
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Briefly state your experience with Homeopathic Medicine. You may attach another sheet if more space is needed.
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Education:
Full Name of Institution Dates of Attendance Degree Obtained Year
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Signature Date