Print Version of Application.

Application Information
Personal Information

* First Name:

* Last Name:

* e-Mail:

Street Address:

City:

Province/State:

Postal Code:

Country:

Day Phone:

Night Phone:

Educational Background

College / University:

Address:

Degree Earned:

Health Care Practitioner Background

Practitioner Title:

Type of License Held:

Please use the space below to state your desire in pursuing this program
For which course/dates are you interested?:
Important Additional Details

If you wish to apply by postal mail print this form - include it with a cheque for $1467.87 (Can) and a photocopy of your current college registration and mail it to the address below.

If you wish to apply and pay electronically – email a scanned image (.jpg file) of your current college registration to: rlmcd@rogers.com Then e-transfer $1467.87 (Canadian) to: rlmcd@rogers.com

There is not an application fee for the Quanta, however, the fee for the course is due upon acceptance and you will not be enrolled without payment.

CANADA COURSE:
Mail to:
OSTEOPATHIC COLLEGE OF ONTARIO
18 Crown Steel Drive, Suite 308
Markham, Ontario L3R 9X8 CANADA
Phone: (647) 477-2071
Fax: (905) 947-1705





l