Form Doh 685-005 - Education Completed
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1Education Completed
This form is required of all applicants prior to a license being issued. Please make copies if more
space is required.
Applicant Name __________________________________________________________________
Western Science Courses (all courses taken from any school)
Equivalent to this
Title of course
Year
Name of school/program
Credits
required course
Microbiology
(Example) 1994
University of Washington
Biology 102
3
East Asian Medicine Education Completed
Equivalent to this
Name of school/program
Title of course
Credits
Year
required course
East Asian Medicine
Fundamental Principles
(Example) 1997
Bastyr
5
Theory
of East Asian Medicine
DOH 685-005 June 2016
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