Center for Traditional Medicine
Registration
PMB 214, 1001 Cooper Point RD SW 140
Olympia, Washington 98502 USA
Phone: (360) 586-0117
Fax (253) 276-0084
lekorn@cwis.org

You may mail in your application or you may fill out our web form.

To mail in application - Download and fill out the application form and to send to us: 
(Please send your printed application and payment to Center for Traditional Medicine. If you have questions do not hesitate to contact Dr. Leslie Korn, Director via email: lekorn@cwis.org

To use Online application
(Please fill out this form and press the submit button, at bottom of page, if you are paying with a credit card only.

Directions: 
Enter information in to each field and press Tab or click in next box to move on.
Pressing RETURN will submit the form.

Section 1: Personal Information
Certificate Title  Enrollment Year
Name Inst. Affiliation
Address City / Town
St/Prv: Postcode
Phone Work Phone Home
Fax Email
Age  Sex Female Male Country
 
Section 2: Questions

Current Degrees, School, and date of receipt: ( e.g. BA University of
Washington, 2000., etc

Current Licenses or Certificates (e.g. CNT, Nutritional Therapy
Association, Olympia, 2005)

What is your academic, professional, or other background?
(Please use 1 - 2 pages.)

What are your goals for internship, certificate or MA degree?
(Please use 1 - 2 pages.)

Are you applying for the Masters Degree option? Yes No

Proposed Entrance Date?

 
Section 3: Financial

Note: There is a $50 application fee (Non-refundable) to process your application.

Payment Method Visa MasterCard American Express
Card holders Name
Card number
Expiration Date Month Year

 

CTM separator Image
REGISTERED APTA  Educator and Practitioner