Personal Details First Name* Last Name* Email* Phone* Website Address* City* State (U.S. Residents) —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Province (Outside U.S.) Country* —Please choose an option—AfghanistanAlbaniaAlgeriaAndorraAngolaAnguillaAntigua & BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChina - Hong Kong / MacauColombiaComorosCongoCongo, Democratic Republic of (DRC)Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench GuianaGabonGambiaGeorgiaGermanyGhanaGreat BritainGreeceGrenadaGuadeloupeGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIsrael and the Occupied TerritoriesItalyIvory Coast (Cote d'Ivoire)JamaicaJapanJordanKazakhstanKenyaKorea, Democratic Republic of (North Korea)Korea, Republic of (South Korea)KosovoKuwaitKyrgyz Republic (Kyrgyzstan)LaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedonia, Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMartiniqueMauritaniaMauritiusMayotteMexicoMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar/BurmaNamibiaNepalNew ZealandNicaraguaNigerNigeriaNorwayOmanPacific IslandsPakistanPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovak Republic (Slovakia)SloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTajikistanTanzaniaThailandNetherlandsTimor LesteTogoTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IslandsUgandaUkraineUnited Arab EmiratesUnited States of America (USA)UruguayUzbekistanVenezuelaVietnamVirgin Islands (UK)Virgin Islands (US)YemenZambiaZimbabwe Zip Code* Prerequisites Level I Program Details Please include details of your level I certification program. Program Title* Institution Name* Institution Location* Institution Phone* Institution Email* Is your level I program NAMA-approved?* —Please choose an option—YesNo Certificate of Completion* Transcript* Level II Program Details Please include details of your level II certification program. Program Title* Institution Name* Institution Location* Institution Phone* Institution Email* Is your level II program NAMA-approved?* —Please choose an option—YesNo Certificate of Completion* Transcript* Anatomy & Physiology Anatomy & Physiology is not required to join the program, though it is a corequisite required for certification. Have you completed the A&P corequisite?* —Please choose an option—YesNo If you have completed the A&P corequisite and not previously submitted documentation, please include your certificate of completion or transcript. Experience and Training Ayurvedic List and describe any relevant professional Ayurvedic experience List and describe additional Ayurvedic workshops or training you have taken with other institutions General List and describe any relevant training and certifications in other areas of study What's your highest level of education* —Please choose an option—High school diploma or equivalentSome college, no degreePostsecondary non-degree awardAssociate’s degreeBachelor’s degreeMaster’s degreeDoctoral or professional degree Professional Community U.S. Residents International residents may skip this section. Are you a NAMA member? —Please choose an option—YesNo If yes, what's your NAMA membership level? Level I - Ayurvedic Health Counselor (AHC)Level II - Ayurvedic Practitioner (AP)Level III - Ayurvedic Doctor (AD)Ayurvedic Yoga Therapist (AYT)Panchakarma Technician (PKT) International Residents U.S. residents may skip this section. Are you involved in a local professional Ayurvedic Organization? —Please choose an option—YesNo If yes, please describe? Academic Goals Essay Questions Please answer the following in 500-750 words. What brought you to Ayurveda?* How do you envision your future with Ayurveda?* Specialty & Eligibility Do you have a preferred clinical specialty?* —Please choose an option—Kayachikitsa: Ayurvedic General MedicineManasaroga: Ayurvedic PsychiatryStreeroga and Prasooti Tantra: Women’s HealthDigestive and Metabolic DisordersUndecided Please describe your other commitments and approximately how much time you can dedicate to your AD studies* Are you legally allowed to visit India?* —Please choose an option—YesNo If you are not legally allowed to visit India, please explain References Please provide details for two references our Admissions team may contact. Reference 1 Full Name* Phone* Email* Reference 2 Full Name* Phone* Email* Submission Please double check your entries on this form to ensure all fields are complete. Checklist* Reviewed AD prerequisites and affirm I am qualified to enroll in this program Uploaded level I program certificate of completion Uploaded level I program transcript Uploaded level II program certificate of completion Uploaded level II program transcript Completed all required fields with an orange asterisk Completed all fields associated with my location, U.S. our International (outside U.S.) Please confirm your agreement to the terms of this application* I confirm that all experience and skills shared in this application are accurate to my identity and capabilities. I apply with full intention of enrolling in the Ayurvedic Doctor program. I understand that if elements of this application are incomplete, it will slow down the application processing time. Δ