Application for Admission: Diploma of Acupuncture
Complete this form to apply to Autumn Institute of Health's Diploma of Acupuncture Program.If you have any questions, please email us at
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Full-time or part-time status can be changed during the program. Please select your intention for your first term.
Date of Birth
Emergency Contact


Please provide the following information for all high schools, colleges and universities that you have attended in the order of attendance from most to least recent: Institution Names, Dates of Attendance, Major, Degree/Qualifications Earned*
English Language Skill
Please select the one that best describes you.

Letter of Reference

Please upload a letter of reference from a person outside of your family, ideally someone who knows you in a professional or academic context. Additionally, provide their contact information below.
Click or drag a file to this area to upload.

Supporting Documents

Click or drag files to this area to upload.You can upload up to 10 files.
Please include all transcripts for any post-secondary education you have completed. If you are a transfer student, please include transcripts or grade reports of the courses you have completed so far.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.


I attest that all information provided on this application is accurate.
I am aware that deliberate falsification of any admissions information may be grounds for rejection or dismissal from Autumn Institute of Health.

Application Fee

Please send the $75 application fee by e-transfer to Alternatively, you may contact us to arrange for cash or cheque payment.