APPLICATION FOR ADMISSION

Texas Health and Science University

4005 MANCHACA ROAD
AUSTIN, TX 78704

Phone:512.448.9999
FAX:512.444.6345

admissions@thsu.edu
www.thsu.edu

Please check the semester and year you would like to attend:
Program to which you are applying:
Bachelors of Science in Traditional Chinese Medicine
Masters of Science in Acupuncture and Oriental Medicine
Doctor of Acupuncture and Oriental Medicine
Dual Degree
Master of Business Administration
Master of Business Administration in Healthcare Management
A. APPLICATION DATA (Please print or type all information, sign and date):
Name Social Security No
  Last First Middle    
Mailing Address
  Street City
State Zip Country
Phones
Home Phone Work Phone Cell Phone Email
Date of Birth Gender Male Female
Are you a U.S. Citizen Yes No If no, list visa or residency status:
Country of Birth If foreign applicant, are you applying for a student visa?
If your native language is not English, note TOEFL score: Date TOEFL Taken:
Driver License No. State Expiration Date:
Emergency Contact Information:
Name
Name Home Phone Cell Phone Work Phone
Address
  Street City State Zip
B. INTERNATIONAL STUDENTS (Required from foreign students):
Statement of Financial Support
U.S. laws require you to establish your means of support while attending school. Please list your sources of support and include documentary evidence and your sponsor's letter of support with this application.
1. Estimate of available personal funds Monthly Amount
2. Estimate of funds from parent/family Monthly Amount
3. Other sources of support(specify) Monthly Amount
Estimate of total monthly support Total Annual Amount
C. Education (List all colleges and post-secondary schools attended, without exception):
SCHOOL OR COLLEGE CITY & STATE DATES ATTENDED DEGREES & MAJOR
List any special honors or recognitions recieved:
D. WORK & PROFESSIONAL EXPERIENCE (Beginning with most recent):
DATES JOB TITLE NAME OF ORGANIZATION & LOCATION NATURE OF WORK
E. Have you ever had a professional license revoked or suspended?
Yes No
If yes explain:
F. OPTIONAL INFORMATION
How did you first learn about THSU?
G. FINANCIAL DATA (THSU reserves the right to conduct credit check if there is just cause to do so.)
1. How will you pay tuition? Savings Employment Loan Other
2. Do you plan to apply for Federal financial aid or benefits? Yes No   
If yes, Please call our Financial Aid Officer for assistance as soon as possible.
3. Have you ever defaulted on a student loan or declared bankruptcy? Yes No
if yes explain:
H. RELATIVES (Identify three persons who are relatives):
NAME RELATION ADDRESS PHONE
I. REFERENCES (Identify three persons who are knowledgeable of your skills and abilities):
NAME POSITION ADDRESS PHONE
J. APPLICATION CHECKLIST
Non-refundable application fee of $75 for resident students and foreign students who reside in the U.S., payable to Texas Health and Science University. Application fee for foreign students who reside outside the U.S. is $150 and an evaluation fee of $200 for overseas documents (transcripts, credentials, etc.)
Complete and official transcripts mailed in a sealed envelop directly from the institution where course work was completed. Foreign students must provide English translation of official documents.
Copies of licenses or certificates in the healing arts (if any).
Two (2) face photographs of passport quality and size.
A letter of interest explaining your reasons for wanting to attend THSU.
Two (2) letters of recommendation.
A photocopy of your driver's license or passport.
I attest that, to the best of my knowledge, all statements made in this application are complete and true. I understand that any falsification as well as failure to submit all required documents may result in denial of this application, or my subsequent dismissal from Texas Health and Science University.
SIGNATURE DATE
FOR OFFICE USE ONLY
DATE APPLICATION RECEIVED: NUMBER OF CREDIT HOURS: