WIT UK Application Form

WIT UK Application

Fill the form below accurately, indicating your experience and suitability for a place on this training.
Name: *

First Name(s) Last Name
Birth Date: *

Month Day Year
Phone Number: *

Country Code Area Code Phone Number
E-mail Address: *
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Please upload a photo of yourself: *
Life Skills & Training
What and when was your last serious study? *
Work Experience - Please tell us about any significant work you have undertaken, paid or unpaid. *
Please indicate your level of experience or knowledge relevant to complementary or Chinese medicine and healing.
What has motivated you to want to study acupuncture? (up to max 500 words) *
Please provide any other information you feel may be relevant to your application (up to max 500 words).
If you have a disability that you would like WIT UK to know about, please give details. Please note that WIT UK has an equal opportunities policy and will consider people with disabilities as long as the basic criteria are met.
References

Please list the names and email/telephone details of two people (not relations) who have known you for a minimum of three years and are prepared to give a reference as to your suitability for the training. One should be a current or previous employer, or teacher/tutor. One could be your acupuncture practitioner if you have one.
Reference 1
Name: *

First Name Last Name
E-mail Address: *
example@example.com
Phone Number: *

Country Code Area Code Phone Number
Years Known: *
Reference 2
Name: *

First Name Last Name
E-mail Address: *
example@example.com
Phone Number: *

Country Code Area Code Phone Number
Years Known: *
How did you find out about WIT UK?

Your Acupuncturist Colleague Worsley Institute Facebook Other (please specify)
Others:
Should be Empty: