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Thank you for considering our school for your educational needs. Please complete the below given form so that one of our school associate will contact you via phone or email and will provide you the requested information.

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* Indicates Required Fields
 
* What is your preferred campus location?
 
   
--Select--
  • Acupuncture Massage College
  
 
* Which program are you interested in?
 
   
--Select--
  
 
  How did you hear about us?
 
 
--Select--
  • Acufinder
  • AMC Website
  • Beacon-FIU
  • Bus Bench
  • Community Newspaper
  • Direct Mail
  • Fair - FIU
  • Fair - High School
  • Fair - Miami Dade
  • Fair - Other
  • Herald - Neighbors
  • Holistic Junction
  • Natural Awakening
  • Natural Healers
  • Referral
  • Sign
  • Voc Rehab
  • Walk In
  • Workforce
  • Yellow Pages
 
  What is your current education level?
 
 
--Select--
  • Associates Degree
  • Associates Degree-AP
  • Bachelors Degree
  • GED
  • General Studies Courses
  • General Studies Courses-AP
  • Graduate School
  • High School
  • High School Diploma
  • In Progress
  • Masters Degree
  • Medical Doctor
  • Ocupational Associates Degree
  • PhD
  • Post Secondary
  • Unknown
  • Vocational Diploma
 
 
 
* Indicates Required Fields
 
* First Name:
 
Middle Name:
 
* Last Name:
 
* Date of Birth: (Ex: MM/DD/YYYY)
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* Gender:
--Select--
  • Female
  • Male
 
* Primary Phone Number: (Ex: 9999999999)
     
 
Alternate Phone Number: (Ex: 9999999999)
  
 
* Primary Email Address:
 
Alternate Email Address:
 
* Address 1 :    Address 2 :


* City : * State :
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  • Alabama
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  • American Samoa
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  • District of Columbia
  • Federated States of Micronesia
  • Florida
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  • Idaho
  • Illinois
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  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Manitoba
  • Marshall Islands
  • Maryland
  • Massachusetts
  • Michigan
  • Military-Americas
  • Military-Europe
  • Military-Pacific
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Brunswick
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • Newfoundland
  • Newfoundland And Labrador
  • North Carolina
  • North Dakota
  • Northern Marianas
  • Northwest Territories
  • Nova Scotia
  • Nunavut
  • Ohio
  • Oklahoma
  • Ontario
  • Oregon
  • Other State
  • Palau
  • Pennsylvania
  • Prince Edward Island
  • Puerto Rico
  • Quebec
  • Rhode Island
  • Saskatchewan
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virgin Islands
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
  • Yukon
 
* Zip : County : Country :
--Select--
  • Broward
  • Dade
  • Monroe
  • Palm Beach
USA
  • Pureto Rico
  • South Korea
  • Sweden
  • USA
 
 



This section is completely optional.You can skip this section by clicking on Save & Continue button below.


Race :
--Select--
  • 2 or More Races
  • American Indian/Alaskan Native
  • Asian
  • Black/African American
  • Hispanic
  • Native Hawaiian or Pacific Islander
  • Nonresident alien
  • Race/ethnicity unknown
  • Two or more races
  • White
 
Nationality :
--Select--
  • American
  • Argentinan
  • Australia
  • Bahamian
  • Brazilian
  • Chinese
  • Colombian
  • Costa Rican
  • Cuban
  • Dominican
  • Ecuadorian
  • Filipino
  • French
  • German
  • Haitian
  • Italian
  • Jamaican
  • Korean
  • Lebanese
  • Loas
  • Nepali
  • Nicaraguan
  • Peruvian
  • Polish
  • Puerto Rican
  • Russian
  • Salvadorian
  • Taiwan
  • Thai
  • Trinidadian
  • Venezuelan
  • Vietnamese
 
Citizenship Status :
--Select--
  • American
  • Argentina
  • Australian
  • Brazil
  • Brazil
  • Chile
  • China
  • Colombia
  • Costa Rica
  • Cuba
  • Ecuador
  • Eligible Non Citizen
  • Filipin
  • French
  • Honduras
  • Italian
  • Lebanese
  • Nepal
  • Nicaragua
  • Nigeria
  • Non Citizen
  • Peru
  • Russian
  • Salvador
  • Trinidad
  • Uruguay
  • US Citizen
  • Venezuela
  • Vietnamese
 
Marital Status :
--Select--
  • Divorced
  • Married
  • Remarried
  • Seperated
  • Single
  • Widowed
 
Family Income :
--Select--
  • $0-30,000
  • $110,001 and more
  • $30,001- 48,000
  • $48,001- 75,000
  • $75,001- 110,000
  • 10,000-19,999
  • 20,000-30,000
  • Over 30,000
  • Under 10,000
  • Unknown
 
Number of Dependents :
 
Driver's License State :
--Select--
  • Alabama
  • Alaska
  • Alberta
  • American Samoa
  • Arizona
  • Arkansas
  • British Columbia
  • California
  • Canal Zone
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Federated States of Micronesia
  • Florida
  • Georgia
  • Guam
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Manitoba
  • Marshall Islands
  • Maryland
  • Massachusetts
  • Michigan
  • Military-Americas
  • Military-Europe
  • Military-Pacific
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Brunswick
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • Newfoundland
  • Newfoundland And Labrador
  • North Carolina
  • North Dakota
  • Northern Marianas
  • Northwest Territories
  • Nova Scotia
  • Nunavut
  • Ohio
  • Oklahoma
  • Ontario
  • Oregon
  • Other State
  • Palau
  • Pennsylvania
  • Prince Edward Island
  • Puerto Rico
  • Quebec
  • Rhode Island
  • Saskatchewan
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virgin Islands
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
  • Yukon
 
Driver's License Number :
 
 


Preferred date and time:
 
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<<<February 2023>>>
February 2023
 SMTWTFS
52930311234
6567891011
712131415161718
819202122232425
92627281234
10567891011
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