Osteopathic Practice And Science Diploma Program Application Form Page 2
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1
2W
I
Y
A
AOS:
HAT
NFLUENCED
OU TO
PPLY TO
Osteopathy Student/Alumni (please indicate name) _______________________________
Website Advertisement
Other Person (please indicate name) __________________________
Email Advertisement
AOS Information Session
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________________
A
A
:
PPLICANT
CKNOWLEDGEMENT
Your personal information is collected for the purpose of processing your application and if the applicant is enrolled,
to establish necessary records to manage and document your educational experience. If you have any questions on this
collection please direct those inquiries to the
I acknowledge, read and understand the Admissions Policies and Procedures.
Signature: ____________________________________________
Date: _________________________________
D
S
:
ECLARATION
TATEMENT
In submitting this application, I declare that the information in this application is correct and complete. I acknowledge my understanding
that any applicant who submits documents or forms that are falsified or fraudulent, and/or who does not fully and accurately disclose the
requisite information as set forth herein or in related documents, may be denied admission to AOS and if it occurs or is discovered
after admission, may be expelled from AOS.
I acknowledge my understanding that applicants are obligated to include attendance, past attendance and enrolment at other
post-secondary institutions on the application.
Further, in submitting this application, I agree to be governed by the policies, rules and regulations as set forth by AOS.
Signature: ____________________________________________
Date: _________________________________
P
AYMENT
Indicate the fees that you will be paying:
$150.00 Application Fee
Visa or Mastercard (please f i ll out below only if mailing)
Cash or Debit (in person only)
Money Order or Cheque
Card Number:
Expiry Date
VIN #
Name as it appears on card:
Cardholder Signature X ______________________________________
Thank you for your interest in the AOS osteopathic practice diploma program!
AOS Toronto Head Office
542 Mt Pleasant Rd #201, Toronto, ON M4S 2M7
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