Name
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First Name
Last Name
Email
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Phone
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(###)
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Date of Birth
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MM
DD
YYYY
U.S. Citizen/Permanent Resident
*
If no, please list:
Country of Citizenship, Visa Type, and Issue Date
Emergency Contact Phone Number
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(###)
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Current Occupation
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Employer
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Do you have a High School diploma or equivalency document?
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Email high school transcript or higher education transcript.
Have you taken the required college level anatomy and physiology class?*
*
Email transcript with grade and date or enrollment documentation.
Education Background
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Please list any post-secondary (institute/university) education as well as any other certificate or professional training you have obtained.
Please list: 1) Institution Name and Address 2) Dates Enrolled and 3) Diplomas Received.
Professional Experience
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Please let us know if you have any professional experience in conventional healthcare, integrative healthcare, sister sciences (ex. yoga, medical astrology, vastu), or other similar experience. Please note: no Ayurveda or healthcare experience is required for AHC!
Select the program you are applying for:
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Are you a transfer student?
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If you are applying for the Ayurvedic Practitioner program, have you completed your AHC at the MNIA?
If you have not taken AHC at MNIA, email your AHC transcript from the institution you took it at.
If you are applying for the clinical internship only, which program have you completed
Email a transcript of the program you have completed.
Are you interested in appearing for the NAMA certification exam?
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Yes
No
Not sure
N/A
Briefly describe your current knowledge of Ayurveda.
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We would like to hear about what you hope to learn and achieve from studying Ayurveda.
Why are you interested in studying at the Minnesota Institute of Ayurveda?
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We would also like to hear about your plans following completions of the program, if any.
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Please feel free to tell us anything else about yourself that you would like us to know.
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By typing my name below, I declare that the information I have submitted for this application is true to the best of my knowledge. I also acknowledge that I will pay the application fee $103.
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First Name
Last Name
Date
*
