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The spirit that endows all things with life is Love.
- Tschu-Li
   

Online Application for Admission

Please note that you will require at least 10-15 minutes to fill this form. You will not be able to save your work and come back at a later date to complete where you left off. You will need to start a new application at that time.

* Indicates required fields

1. Select the campus you wish to attend:
* San Diego Campus New York Campus Chicago Campus
   
2. Applying for program:
*(Please select at least 1 program)
Master of Science Traditional Oriental Medicine(MSTOM)
Masters of Science of Acupuncture (New York)
Tui Na Certificate(San Diego, Chicago)
Herbology Certification(New York)
Bachelor of Health Science(San Diego)
Bachelor of Science Asian Holistic Health and Massage(Chicago)
Bachelor of Professional Studies(New York)
Associate of Occupational Science(New York)
Associate of Applied Science(San Diego)
Massage Technician
Massage Therapist/Asian Bodywork
Public Education
Non-Matriculated Student
DAOM
*Beginning: Year *Semester: Fall Winter Spring
 
3. Personal Information:
*First Name:
Middle Name:
*Last Name:
   
*Present Address:
*City:
*State:
*Zip:
*Country:
   
*Home Phone:
Business Phone:
*Email Address:
*Confirm Email:
Fax, if available:
   
  Is your permanent address the same as your present address?
No Yes
Permanent Address:
City:
State:
Zip:
Country:
Home Phone:
Business Phone:
   
*Date of Birth:
(mm/dd/yy)
*Age:
*Country of Birth:
*Sex:
 Male Female
   
4. If you are a US Citizen, please select "Not applicable"
If you are not a U.S. Citizen, what is your country of citizenship?
Answer:
Do you have, or are you planning to apply for a student (F-1 or M-1) visa?
*Answer:
 Yes Not applicable
 
If yes, answer a-d. If not applicable, go to 5
a) The I-20 should be sent to (check one):
Answer:
 Permanent address Present Address
b) My financial sponsor is (include name and relationship):
Answer:
c) Will you be bringing your spouse and/or children?
Answer:
 Yes No
  If yes, please write the first and last name, date of birth, country of birth and relationship of each dependant in the box below:
Answer:
d) Were you enrolled in another U.S. College/School within 5 months of enrollment at Pacific College?
Answer:
 Yes No
   
5.
Have you applied previously to Pacific College?
*Answer:
 Yes No
If yes, what year:
   
6. Prior Education:
Please chronologically list your high school and all colleges and universities attended:
   
High School Info. is required
 *High School: College1:
Name of Institution:
From:
To:
Major:
Degree/Diploma or # of Units*:
GPA:
   
  College2: College3:
Name of Institution:
From:
To:
Major:
Degree/Diploma or # of Units*:
GPA:
   
  Write down additional College's in the same format as above
 
  *Please indicate whether quarter units, trimester units, or semester units
   
7. Personal Statement:

Directives for the "Personal Statement" (needs to be mailed)

  1. Describe what you think makes you a good candidate to become an Oriental medicine practitioner.
  2. Discuss experiences you have had and how these experiences and your values could make a contribution to your own and your patients' healthcare.
  3. As this education is also a process of self exploration, identify some ways you hope to develop personally on your journey to becoming a healer and how you envision that process.
   
8. In case of emergency, notify:
*Name:
*Phone:
*Address:
*City:
*State:
*Zip:
*Country:
   
9. Personal Limitations: (optional)
Please describe any physical or other limitations which may require special planning.
Answer:
   
10. Plans to finance education:
Are you able to completely finance your own education (tuition, fees, living expenses, transportation, etc.)?
*Answer:
 Yes No  
If no, please estimate the amount of supplementary funds you will need from grants, loans, scholarships or other personal sources during your enrollment at Pacific College:
Answer $:
If yes, from what sources?
Answer:
   
11. Employment and volunteer service:
Please list all paid employment (full and part-time) and/or voluntary service for at least the last three years beginning with your most recent position:
From Month/Year
To Month/Year
Total months
Hours per wk
Position
Organization
City & State
   
12. References:
Please ask the individual who is writing the recommendation to mail their reference letter directly to your Admissions Counselor's attention at the campus you are planning to attend.
   
13. Racial/Ethnic status (optional): Check one box only:
  White non Hispanic, Black non Hispanic, Hispanic
Asian/Pacific Islander American Indian/Alaskan Native
 
14. Other information:
Please indicate any additional information you believe would be helpful to us in considering your application.
Answer:
 
15. Agreement Confirmation:
I hereby make Application for Admission to Pacific College of Oriental Medicine, and certify that all information given on this application is true. I authorize Pacific College to investigate all statements on my application and to request a consumer credit report.
*Check this Box if you agree with the above statement:
 

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An Admissions Counselor will contact you soon after you submit this form. Please complete the following related items in the Application Check List below.

If there are any questions regarding the application process, contact the Admissions dept. to the campus you are applying.

Email:
San Diego: admissions-sd@pacificcollege.edu
New York: admissions-ny@pacificcollege.edu
Chicago: admissions-chi@pacificcollege.edu

San Diego:
7445 Mission Valley Road
Suite 105
San Diego, CA 92108

Phone: (619) 574-6909
Toll free: (800) 729-0941
Fax: (619) 574-6641

New York:
915 Broadway
2nd Floor
New York, NY, 10010

Phone: (212) 982-3456
Toll free: (800) 729-3468
Fax: (212) 982-6514

Chicago:
3646 N. Broadway
2nd Floor
Chicago, IL 60613

Phone: (773) 477-4822
Toll free: (888) 729-4811
Fax: (773) 477-4109

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Application Check List:

An application is complete when ALL of the following have been received or completed:

  • A completed Application Form
  • An application fee ($50 US / $100 International) - Click here to pay online.
  • A personal statement (typed essay)
  • Official transcripts from all colleges attended, mailed directly to Pacific College from your previous college
  • Proof of immunization (N.Y. only)
  • An academic evaluation (required for International schools only)
  • An Affidavit of Financial Resources (I-20 applicants only)
  • One passport photograph
  • Two letters of reference. (Optional for non-degree programs)
  • Admissions interview
  • High School Transcript(All programs except master and bachelor degrees)
 

 
 
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